HomeMy WebLinkAbout20103027.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of Weld Month of November, 2010
SECTION I: GENERAL INFORMATION
Telephone Calls 326 Correspondence Received 8
Office(Public Contacts) 120 Correspondence Written 203
Home Visits 0 Information and Referral/Inquiries 49
Outreach Visits (i.e. NH...) 1 Other (i.e: VCAA Notice Response) 4
Community Events/Forums 0 State Benefit(s) s
Request for Medals 2 Request for Military Records &Corrections
Operation Recognition 0 SF-180 10
DD 149 1
Request for Medical Treatment Records DD 293 0
21-4142 I 1i NA 13075 0
Other L. ) 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 1 21-534 4
21-22 Other 1 w/Accrued Benefits n
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC - New/) 5 10-10 EZ 11
21-4138 (SC - Informal Claim) 10-10 EZ-R 2
21-4138 (SC - New Issue) 0 10-583 0
21-4138 (SC - Reopen) 1, 10-10d (CHAMPVA- Dependents) 0
21-4138 (SC - Increase) 1 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) 0 Vocational Rehabilitation
21-8940 (IU) 0 28-1900 CH 31 1
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 4 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 1 21-674 n
21-4138 (Reinstatement) 0
EVR (Any) 2 Miscellaneous Claims
21-8416 1 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 7 Medicaid Application Assistance 0
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
CVA-26/Revised 9/1/200 1
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SECTION II (Continued):
Burial Allowance Claims for Insurance
21-530 1 29 -357 0
40-1330 1 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 6 Requests wl VTF (Grant), #Vets Assisted
26-1817 9 Rental Assistance 0
Utilities Assistance 0
Homeless Veterans Claims Filed Prescription Assistance/Other Medical 0
SC n 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 1
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 November 20 10 from Weld County:
Salary $4,310.09
Expenses None
Office Space None
Telephone 64.48
Office Supplies None
Travel None
Training Conference None
Other Copier 96.00
Other Postage 84. 10
Total $4,554.67
u /O
(Signature of County terans Service Officer) / (Date)
Dorothy Strong, Veterans ounselor for U
Pat Persichino, Veterans Service Officer
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordanc 'th CRS 28-5-707 I hereby certify the accuracy of t Re ort(CVAT2,p, revis /1/2006):
, 3ji Strong,
, e Art „f_%r/ County Commissio r or Desig axis Cour
Dougl s Rade acher, Chair /'I
WEld County
12/22/2010 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 9/1/2006)
atio-3d
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