HomeMy WebLinkAbout20101577.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS -MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of Weld Month of June, 2010
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SECTION I: GENERAL INFORMATION rr ` ,`''.•`""':."-"".'
Telephone Calls i A•; Correspondence Received ', -%�)1- + It �� 20
Office (Public Contacts) Correspondence Written 19
Home Visits 0 Information and Referral/inquiries,,,; ; V :) 21
Outreach Visits (i.e. NH...) 0 Other (i.e: VCAA Notice Response) 2
Community Events/Forums 1 State Benefit(s) 3
Request for Medals I Request for Military Records &Corrections
Operation Recognition 0 SF-180 10
DD 149 0
Request for Medical Treatment Records DD 293 0
21-4142 I 3 NA 13075 0
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 U 21-534 4
21-22 Other - 4 w./Accrued Benefits 0
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC - New/) 5 10-10 EZ 10
21-4138 (SC - Informal Claim) 0 10-10 EZ-R 3
21-4138 (SC - New Issue) 0 10-583 0
21-4138 (SC - Reopen) 0 10-10d (CHAMPVA - Dependents) 0
21-4138 (SC - Increase) 2 10-7959a (CHAMPVA) 0
21-4138 (SC - Secondary/Aggravation) 1 10-7959C (CHAMPVA - Insurance Cert 0
21-4138 (SC - Reinstatement) 0
21-4138 (SC wl IU) 0 Vocational Rehabilitation
21-8940 (IU) 1 28-1900 CH 31 2
21-4192 (IU - Employer) 0 28-1900 (Independent Living Program) 0
21-4138 (SMC) 0
21-686c 2 Educational Assistance Programs
MGIB CH 30 1 0
Non Service Connected Pension: VEAP CH 32 0
21-526 h VN Era GI CH 34 0
21-527 n 22-5490 CH 35 0
686c 2 Sel Reservist NG CH 1607 0
21-526/527 w/A&A 2 21-674 0
21-4138 (Reinstatement) 0
EVR (Any) 0 Miscellaneous Claims
21-8416 8 21-8678 (Clothing Allowance) 0
5655 3 21-4502 (Auto Grant/Adaptive Equipment) 0
26-4555 (Housing Grant) 0
Request for Waivers/Compromise: 10-0103 (HISA Grant) 0
21-4138 2 Medicaid Application Assistance 0
5655 (FSR) 2 SSA Application Assistance 0
Other(Specify) 0
Dependent Indemnity Compensation (DIC) Other (Specify) U
21-534
1 Other (Specify) U
w/Accrued Benefits 0
VY t CVA-26(Revised 9/1/2006)
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SECTION II (Continued):
Burial Allowance Claims for Insurance
21-530 0 29 -357 0
40-1330 0 29-4364 0
21-2008 O 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 1 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 June , 2010 from Weld County:
Salary $4,310.09
Expenses None
Office Space County pays utilities in lieu of rent
Telephone 168.85
Office Supplies None
Travel None
Training Conference None
Other Copier 96.00
Other Internet 82.99
82p99
Other t Postage $4,6/S:91+utilities --
Z&A...01/aclja / -(Signature of Couneterans Service Offi ) (Date)
Dorothy Strong, Veterans Counselor for
Pat Persichino, Veterans Service Officer
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with C, -707, I hereby
^certify the accuracy oft eport Cy�9--2166,, revi . 9/1/2006 :
0.14/1 7 Erg Dorothy u rong, Vet rans ounselo
County Commissioner or Designee of
jug);_>-11s Ra macher, Chair
eld County
JUN 19 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)
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