HomeMy WebLinkAbout20101031.tiff State of Colorado
Department of Military and Veterans Affairs
;�'' Divison of Veterans Affairs
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r� z : COUNTY VETERANS SERVICE OFFICERS
rq MONTHLY REPORT AND CERTIFICATION •. - , ,. . .,_.„,,
••••• MOF PAY
County: Weld Month of: April , 20 10
SECTION I: GENERAL INFORMATION SECTION II: NEW CLAIMS INITIATED
Telephone Calls 194 Appointed Representative:
Office (Walk-ins) , 21.0 21-22 CVA 0
Home Visits p 21-22 Other 4
Outreach Visits (i.e. NH...) 1
Community Events/Forums _ 0 • Service Connected Disability Compensation
Correspondence Received 14 21-526 I(SC - New/) I 10 •
Correspondence Written I 20 i L21-4138 - Other SC (Inc, Reopen, etc) 5
Information and Referral/Inquiries 18 _
_Contacts: VAMC Vane 63 Dependent Indemnity Compensation (DIC)
Requests for: 21-534 . I 1
Military Records & Corrections _
SF-180 Ili Non-Service Connected Pension
DD 149/293 0 21-526 / 527 1
21-526/527 w/A&A 5
Request for Medical Treatment Records
21-4142 I 1 I 4 Death Pension /Widows Pension
21-534 4
Request for Medals 3 w/Accrued Benefits 0
Operation Recognition • 0
Burial Allowance
Request for State Benefits: I 4 21-530 I 2
Request for VTF Grant Assistance I 0 I Vocational Rehabilitation
28-1900 / CH 31 I 2
Request for VA Healthcare
10-10 EZ 10 Educational Assistance Programs 1
10-10 EZ-R 2 CH 30, 32, 34, 1607 0
CHAMPVA 0 CH 35 n
Miscellaneous Claims Claims for Disability Insurance
Other (Specify) 0 29-357 / 29-4364 1 a
Other (Specify) 0
Other (Specify) 0 VA Home Loan
Other (Specify) 0 26-1800 / 1817 I 2
Appeals
,NOD / DRO / VA9 I 2
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2010-1031
�'U_ v,,4, -i:4i1., C6
�- C� CVA-26(Revised 2/1/2007)
�Y V 1100
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 April 2010 from Weld County:
•
Paid In-Kind •
Salary $ 4.310.09 Salary $
•
Expenses $ None Expenses $
Utilitiggunty pays utilities in lieu of rent Utilities $
Officit'paepays utilities in lieu of rentoffice Space $
Telephone $ 167.84 Telephone $
Internet $ 82.99 Internet $
Office Supplies $ 48.46 Office Supplies $
•
Postage $ 21.91 Postage $
•
Travel $ mono Travel $
Training Conference $ None Training Conference $
Other Copier $ 96.00 Other $
Other $ Other $
TOTAL $ 4,727.29+utilities - TOTAL $
•
• c' g --a)
(Signature of County V erans Service Officer -(Date)
Dorothy Strong, eterans Counselor or'
Pat Persichino, Veterans Service Officer
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with'CRS 28-5-707, I hereby certify the accur y . the Report(CVA-26, revi4. 1/2007):
Dorothy Strong, Vry erans Counselor
G County Commissioner od�esignee
(Signature) •
Douglas Rademacher County Commissioner or Designee of
. (Pdnted/Typed Name) .
Weld •
County
•
• MAY 1 7 2010 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 2/1/2007)
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