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Home My WebLink About20110685.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY COUNTY of Weld Month of December, 2010 SECTION I: GENERAL INFORMATION _ , Telephone Calls 326 Correspondence Received ....ii i::,'! -`'; /. ti5j I Office (Public Contacts) 2O3 Correspondence Written 39 Home Visits o Information and Referral/Inquiries 30 Outreach Visits (i.e. NH...) n Other(i.e: VCAA Notice Respoh§e y "- " - ""-19 Community Events/Forums n State Benefit(s) 4 Request for Medals 2 Request for Military Records &Corrections Operation Recognition 0 SF-180 10 DD 149 6 Request for Medical Treatment Records DD 293 ± 21-4142 I 4 NA 13075 0 Other( ) 0 SECTON II: NEW CLAIMS INITIATED [Provide number of new claims initiated for current reporting month] Appointed Representative: Death Pension /Widows Pension 21-22 CVA 0 21-534 2 21-22 Other 2 w/Accrued Benefits 0 Claims for SC Entitlement: Request for VA Healthcare 21-526 (SC - New/) 11 10-10 EZ ti 21-4138 (SC - Informal Claim) 0 10-10 EZ-R in 21-4138 (SC - New Issue) 0 10-583 0 21-4138 (SC - Reopen) 0 10-10d (CHAMPVA- Dependents) 0 21-4138 (SC - Increase) 0 10-7959a (CHAMPVA) 0 21-4138 (SC - Secondary/Aggravation) 0 10-7959C (CHAMPVA- Insurance Cert 0 21-4138 (SC - Reinstatement) 0 21-4138 (SC w/ IU) 2 Vocational Rehabilitation 21-8940 (IU) 4 28-1900 CH 31 1 21-4192 (IU - Employer) 0 28-1900 (Independent Living Program) 0 21-4138 (SMC) 0 21-686c 2 Educational Assistance Programs MGIB CH 30 0 Non Service Connected Pension: VEAP CH 32 0 21-526 5 VN Era GI CH 34 0 21-527 0 22-5490 CH 35 0 686c Z Sel Reservist NG CH 1607 0 21-526/527w/A&A 4 21-674 0 21-4138 (Reinstatement) 0 EVR (Any) 3 Miscellaneous Claims 21-8416 2 21-8678 (Clothing Allowance) 0 5655 2 21-4502 (Auto Grant/Adaptive Equipment) 0 , 26-4555 (Housing Grant) n Request for Waivers/Compromise: 10-0103 (HISA Grant) a 21-4138 2 Medicaid Application Assistance a 5655 (FSR) 2 SSA Application Assistance 0 Other(Specify) 0 Dependent Indemnity Compensation (DIC) Other(Specify) 0 21-534 1 Other (Specify) 0 w/Accrued Benefits 0 Cl/A-9 1117A7c1,7,/ CA, I .a S\ate 2011-0685 3 - \Li- I I SECTION II (Continued): Burial Allowance Claims for Insurance 21-530 1 29 -357 0 40-1330 0 29-4364 0 21-2008 0 29-336 (Designation of Beneficiary) 0 21-4125 (Claim for Lump Sum Payment) 0 VA Home Loan 26-1800 5 Requests wl VTF (Grant), #Vets Assisted 26-1817 0 Rental Assistance 0 Utilities Assistance 0 Homeless Veterans Claims Filed Prescription Assistance/Other Medical 0 SC 0 Food 0 NSC 0 Transportation 0 Clothing 0 Incarcerated Veterans Other 0 21-4193 Release/Reinstatement 0 21-4138 (Apportionment) 0 Appeals DRO Election NOD 0 Review 0 VA 9 0 Hearing 0 SECTION III: CERTIFICATION BY COUNTY VETERANS SERVICE OFFICER I hereby certify, the above captioned monthly report is true and accurate. I have been paid the following amount(s) for the month of December , 2010 from Weld County: Salary $4,310.09 Expenses None Office Space None Telephone 64.48 Office Supplies None Travel None Training Conference iv,,,,e Other Copier 96.09 Other h Internet 82 99 £0ther Postage 23. 17 $4,577. 73 iet r2+-. j / 1e6� 3 - // ( gnature of Coun Veterans Servi O ioer) (Date) Dorothy Strong fo Pat Persich 'Veterans Service Officer SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE In accordance wi h CRS 28-5-707, I hereby certify the accuracy of -0,Repo VA- , revised 1/20l)F): i Cot S o.. er r�i ehi..e ��L�i oountyfCo Boner o egignee o Barbara irkmeyer, Chairl , Boar of Weld County Commissioners Weld County MAR 1 1 _J ( Date This certification, submitted monthly, properly signed and executed, will be considered as application for the monetary benefits to the County General Fund, in accordance with 28-5-804 (2002) Colorado Revised Statue. This form is to be submitted by the 15th day of the following month. Mail to: Colorado Division of Veterans Affairs Attention: Deputy Director 7465 E. 1st Avenue, Suite C Denver, CO 80230 CVA-26(Revised 9/1/2006) COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY COUNTY of Weld Month of January, 2011 SECTION I: GENERAL INFORMATION Telephone Calls 262 Correspondence Received :r"-ii L',.-! -c1 ,L\ j§-I Office (Public Contacts) 130 Correspondence Written 38 Home Visits 0 Information and Referral/Inquiries 20 Outreach Visits (i.e. NH...) 0 Other(i.e: VCAA Notice Respdrigber' "" �i 5 Community Events/Forums 0 State Benefit(s) 6 Request for Medals 3 Request for Military Records &Corrections Operation Recognition U SF-180 12 DD 149 6 Request for Medical Treatment Records DD 293 0 0 21-4142 I 5 NA 13075 0 Other ( ) SECTON II: NEW CLAIMS INITIATED [Provide number of new claims initiated for current reporting month] Appointed Representative: Death Pension /Widows Pension 21-22 CVA 0 21-534 3 21-22 Other 2 w/Accrued Benefits 0 Claims for SC Entitlement: Request for VA Healthcare 21-526 (SC - New/) q 10-10 EZ 15 21-4138 (SC- Informal Claim) 0 10-10 EZ-R 10 21-4138 (SC - New Issue) 0 10-583 0 21-4138 (SC - Reopen) 0 10-10d (CHAMPVA- Dependents) 0 21-4138 (SC - Increase) 0 10-7959a (CHAMPVA) 0 21-4138 (SC -Secondary/Aggravation) 0 10-7959C (CHAMPVA- Insurance Cert u 21-4138 (SC - Reinstatement) 0 21-4138 (SC w/ IU) 0 Vocational Rehabilitation 21-8940 (IU) it 28-1900 CH 31 2 21-4192 (IU - Employer) 0 28-1900 (Independent Living Program) 0 21-4138 (SMC) 0 21-686c 0 Educational Assistance Programs MGIB CH 30 0 Non Service Connected Pension: VEAP CH 32 0 21-526 i VN Era GI CH 34 0 21-527 0 22-5490 CH 35 0 686c 0 Sel Reservist NG CH 1607 0 21-526/527 w/A&A 6 21-674 0 21-4138 (Reinstatement) n EVR (Any) n Miscellaneous Claims 21-8416 0 21-8678 (Clothing Allowance) 0 5655 0 21-4502 (Auto Grant/Adaptive Equipment) 0 26-4555 (Housing Grant) 0 Request for Waivers/Compromise: 10-0103 (HISA Grant) 0 21-4138 3 Medicaid Application Assistance 0 5655 (FSR) 3 SSA Application Assistance 0 Other(Specify) 0 Dependent Indemnity Compensation (DIC) Other(Specify) 0 21-534 1 Other (Specify) 0 w/Accrued Benefits 0 CVA-26(Revised 9/1/2006) Ccf'. vr , 5+c J 3- /l- If SECTION II (Continued): Burial Allowance Claims for Insurance 21-530 0 29 -357 0 40-1330 0 29-4364 0 21-2008 0 29-336 (Designation of Beneficiary) 0 21-4125 (Claim for Lump Sum Payment) 0 VA Home Loan 26-1800 4 Requests wl VTF (Grant), #Vets Assisted 26-1817 0 Rental Assistance 0 Utilities Assistance 0 Homeless Veterans Claims Filed Prescription Assistance/Other Medical 0 SC 0 Food 0 NSC 0 Transportation 0 Clothing 0 Incarcerated Veterans Other u 21-4193 Release/Reinstatement 0 21-4138 (Apportionment) 0 Appeals DRO Election NOD 2 Review 1 VA 9 0 Hearing 0 SECTION III: CERTIFICATION BY COUNTY VETERANS SERVICE OFFICER I hereby certify, the above captioned monthly report is true and accurate. I have been paid the following amount(s) for the month of TRn,,ary , 2011 from wpm County: Salary $4,310.09 Expenses None Office Space None Telephone 65.33 Office Supplies None Travel None Training Conference None Other Copier 96.00 Other None Postage 26.99 Total $4,583.40 / (Signature y;County Veter- . :e ice Officer) (Date) Dorothy Strong, Veteran .unselor for Pat Persichino, Veterans Service Officer SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE In accordance with CRS 28-5-707, hereby certify the accuracy of ffie Re b (CVA-2 , revis 9/1/2006):, Coalt7xeg i ABBorf®esi§w9®>Djns Service Bar ra irkmeye Lair, oard of County commissioner fficer, P. Persichino Weld County MAN 1 ;1 Date This certification, submitted monthly, properly signed and executed, will be considered as application for the monetary benefits to the County General Fund, in accordance with 28-5-804 (2002) Colorado Revised Statue. This form is to be submitted by the 15th day of the following month. Mail to: Colorado Division of Veterans Affairs Attention: Deputy Director 7465 E. 1st Avenue, Suite C Denver, CO 80230 CVA-26(Revised 9/1/2006) , ,i(2//- K-)71-1?-e- COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY COUNTY of Weld Month of February, 2011 SECTION I: GENERAL INFORMATION Telephone Calls 150 Correspondence Received t lij Li; —rI IA ec ail Office (Public Contacts) 30 Correspondence Written 37 Home Visits 0 Information and Referral/Inquiries . 72 Outreach Visits (i.e. NH...) 0 Other(i.e: VCAA Notice RespartM)''``" ' 'T 3 Community Events/Forums 0 State Benefit(s) 4 Request for Medals 2 Request for Military Records&Corrections Operation Recognition u SF-180 12 DD 149 0 Request for Medical Treatment Records DD 293 0 21-4142 I 0 NA 13075 u Other ( _) u SECTON II: NEW CLAIMS INITIATED [Provide number of new claims initiated for current reporting month] Appointed Representative: • Death Pension /Widows Pension 21-22 CVA 1 21-534 3 21-22 Other 7 w/Accrued Benefits 0 Claims for SC Entitlement: Request for VA Healthcare 21-526 (SC - New/) 7 10-':0 EZ 15 21-4138 (SC - Informal Claim) 0 10-10 EZ-R 9 21-4138 (SC - New Issue) 0 10-583 0 21-4138 (SC - Reopen) 0 10-10d (CHAMPVA- Dependents) 0 21-4138 (SC - Increase) 0 10-7959a (CHAMPVA) u 21-4138 (SC - Secondary/Aggravation) 0 10-7959C (CHAMPVA- Insurance Cert u 21-4138 (SC - Reinstatement) 0 21-4138 (SC w/ IU) 0 Vocational Rehabilitation 21-8940 (IU) 1 28-1900 CH 31 3 21-4192 (IU -Employer) 0 28-1900 (Independent Living Program) 0 21-4138 (SMC) 0 21-686c 0 Educational Assistance Programs MGIB CH 30 0 Non Service Connected Pension: VEAP CH 32 0 21-526 A VN Era GI CH 34 0 21-527 0 22-5490 CH 35 0 686c n Sel Reservist NG CH 1607 0 21-526/527 w/A&A 2 21-674 0 21-4138 (Reinstatement) n EVR (Any) 1 Miscellaneous Claims 21-8416 n 21-8678 (Clothing Allowance) 0 5655 0 21-4502 (Auto Grant/Adaptive Equipment) 9 26-4555 (Housing Grant) p Request for Waivers/Compromise: 10-0103 (HISA Grant) n 21-4138 2 Medicaid Application Assistance n 5655 (FSR) 2 SSA Application Assistance n Other(Specify) n Dependent Indemnity Compensation (DIC) Other(Specify) n 21-534 1 Other(Specify) n w/Accrued Benefits 0 CVA-26(Revised 9/1/2006) Lt.,. Via vi5'.Lt-19 j- 14 -1i SECTION II (Continued): Burial Allowance Claims for Insurance 21-530 2 29 -357 0 40-1330 0 29-4364 0 21-2008 0 29-336 (Designation of Beneficiary) 0 21-4125 (Claim for Lump Sum Payment) 0 VA Home Loan 26-1800 0 Requests wl VTF (Grant), #Vets Assisted 26-1817 0 Rental Assistance 0 Utilities Assistance 0 Homeless Veterans Claims Filed Prescription Assistance/Other Medical 0 SC 0 Food 0 NSC 0 Transportation U Clothing 0 Incarcerated Veterans Other u 21-4193 Release/Reinstatement 0 21-4138 (Apportionment) 0 Appeals DRO Election NOD 2 Review 2 VA 9 0 Hearing 0 SECTION III: CERTIFICATION BY COUNTY VETERANS SERVICE OFFICER I hereby certify, the above captioned monthly report is true and accurate. I have been paid the following amount(s) for the month of February 20 11 from Weld County: Salary $4,310.09 Expenses None Office Space None Telephone 50.05 Office Supplies None Travel None Training Conference None Other Copier 96.00 Other Postage 18. 13 Total $4,474.27 (Signaturelf County Veter S 'rviceOfficer) (Date) Dorothy Strong, Veteran unselor for Pat Persichino, Veterans Service Office SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE In accordance with CRS 28-5-707, I hereby certify the accuracy of the port (CV 26, re ' d 9/1/ 0916): 4D [_ Doroth Str ngn P ers chino Lie Lc County s oner or De e of ar r eyeidl air, Board of Weld County Commissioners County MAR 1 4 2011 Date This certification, submitted monthly, properly signed and executed, will be considered as application for the monetary benefits to the County General Fund, in accordance with 28-5-804 (2002) Colorado Revised Statue. This form is to be submitted by the 15th day of the following month. Mail to: Colorado Division of Veterans Affairs Attention: Deputy Director 7465 E. 1st Avenue, Suite C Denver, CO 80230 CVA-26(Revised 9/1/2006) Hello