HomeMy WebLinkAbout20102442.tiff / COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of Weld Month of August, 2010
' SECTION I: GENERAL INFORMATION
Telepf4di )E'atiis A30204 Correspondence Received 20
Office (Public Contacts) _ _ 183 Correspondence Written 18
Home Visits ?; _, , _;, . 0 Information and Referral/Inquiries 42
Outreach Visits (i.e. NH...) 2 Other(i.e: VCAA Notice Response) 5
Community Events/Forums 0 State Benefit(s) 5
Request for Medals 3 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 11 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 1 21-534
5
21-22 Other 4 w/Accrued Benefits 0
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC - New/) 10 10-10 EZ 10
21-4138 (SC - Informal Claim) 0 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) 3 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) 1 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 n
Non Service Connected Pension: VEAP CH 32 0
21-526 3 VN Era GI CH 34 0
21-527 0 22-5490 CH 35 0
686c 1 Sel Reservist NG CH 1607
0
21-526/527 w/A&A 8 21-674
0
21-4138 (Reinstatement) 1
EVR (Any) 2 Miscellaneous Claims
21-8416 4 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 2 Medicaid Application Assistance 0
5655 (FSR) 2 SSA Application Assistance 0
Other(Specify) 0
Dependent Indemnity Compensation (DIC) Other (Specify) 0
21-534 2 Other(Specify) 0
w/Accrued Benefits n
CVA-26(Revised 9/1/2006)
v AGCf)
2010-2442
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 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 0
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 August , 2010 from Weld County:
Salary $4,310.09
Expenses None
Office Space County pays utilities in lieu of rent
Telephone 173.86
Office Supplies None
Travel None
Training Conference None
Other Copier 96.00
Other Internet 82.99
Other - Postage 46.33
Total $4,709.27 + utilities
(Signature of County eterans Service Office (Date)
Dorothy Strong, Veterans Counselor
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 the ReportteMAI -26, revised 9/1/2006 :
/ e-County Commissioner or Desi ee of Dorothy Si
arba�km er, Cha r Pro-Tern, Board of County Commissions s veterans Couns(
weld County
10/13/2010 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)
dOX) --4 “'
COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
. COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of Weld Month of September, 2010
• SECfON I: GENERAL INFORMATION
Telephone Calls T ) 1:L i —3 J-; r L9 Correspondence Received 23 _
Office (Public Con`facts) 189 Correspondence Written 17
Home Visits 0 Information and Referral/Inquiries ' 45
Outreach Visits (i.e. NH.:,) , • • 2 Other (i.e: VCAA Notice Response) 5
Community Events/Forums 1 State Benefit(s) 6
Request for Medals 4 Request for Military Records &Corrections
Operation Recognition 0 SF-180 13_
DD 149 0
Request for Medical Treatment Records DD 293 1
21-4142 1 13 NA 13075 0
,Other( _ ) 0 i
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Appointed Representative: Death Pension /Widows Pension
21-22 CVA 2 21-534 4
21-22 Other 4 WI Accrued Benefits 0
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC - New/) 1-0 10-10 EZ 12
21-4138 (SC - Informal Claim) 0 10-10 EZ-R 5-
21-4138 (SC - New Issue) 1 10-583 0
21-4138 (SC - Reopen) 1 10-10d (CHAMPVA - Dependents) n r
21-4138 (SC - Increase) 3 10-7959a (CHAMPVA) 0
21-4138 (SC -Smeary/Aggravator) 1 10-7959C (CHAMPVA- Insurance Cert 0
21-4138 (SC - Reinstatement)_ 0
21-4138 (SC wl IU) 0 Vocational Rehabilitation
21-8940 (IU) 2 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 4 VN Era GI CH 34 0
21-527 0 22-5490 CH 35 0
686c 1 Sel Reservist NG CH 1607 0
-
21-526/527 wl A&A 5 21-674 0
21-4138 (Reinstatement) 0 _
EVR (Any) 0 Miscellaneous Claims
21-8416 6 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 1 Medicaid Application Assistance 0
5655 (FSR) 1 'SSA Application Assistance 0
Other (Specify) 0
Dependent Indemnity Compensation (DIC) Other (Specify) 0
21-534 2 Other (Specify) 0
w/Accrued Benefits 0
CVA-26(Revised 9/1/2006)
v P1l;Cc 1
SECTION II (Continued):
Burial Allowance - Claims for Insurance
21-530 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 2 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
NSC 0 Transportation
Clothing 0
Incarcerated Veterans Other 0
21-4193 Release/Reinstatement 1 •
21-4138 (Apportionment) O
Appeals DRO Election
NOD 1 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 September , 20 10 from Weld County:
Salary $4.310.09
Expenses None
Office SpaceCounty pays utilities in lieu of rent
Telephone 168.01
Office Supplies None
Travel None
Training Conference None
Other Copier 96.00
Other Internet 82.99
Other - postage 35.04
Total 84,697 19+utilities
(Signature of County veterans Service Offi4;) (Date)
Dorothy Strong, eterans Counsel for
Pat Persichino, Veterans Service Officer
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-707, I h eby certify the accuracy of the Repo A--26, revise 9/1/
rba� It l k— / -- .4-Countyj, tCounty (G1frw'fl> Yon rw 1ttesaes ns Counsel(
ra Kirkmey , Chair Pro-Tem, Board of Weld County Commissioners
Weld County
•
10/13/2010 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)
3IO/G— ��a
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