HomeMy WebLinkAbout20100701.tiff State of Colorado
Department of Military and Veterans Affairs
c ik Divison of Veterans Affairs
COUNTY VETERANS SERVICE OFFICERS
r '' MONTHLY REPORT AND CERTIFICATION OF PAY
County: Weld
Month of: march , 20_L0__
SECTION I: GENERAL INFORMATION SECTION II: NEW CLAIMS INITIATED
Telephone Calls 214 Appointed Representative: _
118 21-22 CVA 0
Office (Walk-ins) 21-22 Other 4
Home Visits
Outreach Visits (i.e. NH...) 1 Service Connected Disability Compensation
Gommunit Events/Forums 21 526 (SC - New/ 10
Correspondence Received
Correspondence Written 12
21-4138 - Other SC (Inc, Reopen, etc)19
Information and Referral/Inquiries 48 Dependent Indemnity Compensation (DIC)
Requests for: 21-534
Military Records & Corrections
SF-180
Non-Service Connected Pension DD 149/293 2 21-526 / 527 1 21-526/527 w/A&A 4
Request for Medical Treatment Records Death Pension / Widows Pension
21x142 5 21-534 4
Request for Medals 1
w/Accrued Benefits 0
Operation Reco nition 0
Burial Allowance
Request for State Benefits:
21-530 I 7
Vocational Rehabilitation
Request for VTF Grant Assistance ^ — 128-1900 / CH 31 i
Request for VA Healthcare
10-10 EZ
Educational Assistance Programs
O.10-10 EZ-R R CH 30, 32, 34, 1607
y_ -ill
0 CH 35 � 0
CHAMPVA
Miscellaneous Claims Claims for Disability Insurance
Other (Specify) 9-357 1 29-4364 I n
Other Specify)
0 VA Home Loan
Other (Specify) 0 26-18001 1817
Other (Specify)
Appeals
NOD / DRO / VA9 3
ii
V/ root
CVA-26(Revise 2/1/2007
`/7//C (lel' Pete n 2 i2 r11) 1/M 2010-0701
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 March ,20 10 from Weld County:
, Paid In-Kind
Salary $ 4,310.09 Salary $
Expenses $ None Expenses $
UfilikewntY pays utilities in lieu of rent Utilities . $
OfficgPnbiccpays utilities in lieu of rent Office Space $
Telephone $ 168.90 Telephone $
Internet $ 82.99 Internet $
Office Supplies $ None Office Supplies $ -
•
Postage $ 30.98 Postage $ •
Travel $ None • Travel $
Training Conference $ 545 00 Training Conference $
Other Copier $ .96.00 Other $ _
Other Dues (2) $ 40.00. - Other $
TOTAL $ 5,273.96 +utilities TOTAL $
(<16}H. 1461% r/ , c.,---€97o(Signature of County eterans Service Officer (Date)
Dorothy STrong, Veterans Counselor f •
Pat Persichino, Veterans Service Officer
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with'CRS 28-5-707, I hereby certify the accuracy o eReport (CVA- 6 evisedZ/1 2 ):
iC- c
Dorothy Strong, Ve rans Counselor
_1 1� County Commissioner or Desig e
ignature)
Douglas Rademacher, Chair County Commissioner or Designee of
(PrintediTyped Name)
Weld County .
•
04/07/2010 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: Co/orado 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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