HomeMy WebLinkAbout20101826 / COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS -MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of Weld Month of July. 2010
SECTION I: GENERAL INFORMATION
Telephone Calls 7n5 Correspondence Received 17
Office(Public Contacts) 19S Correspondence Written 23
Home Visits n Information and Referral/Inquiries 62
Outreach Visits (i.e. NH...) 1 Other(i.e: VCAA Notice Response) 10
Community Events/Forums 2 State Benefit(s) 8
Request for Medals 2 Request for Military Records&Corrections
Operation Recognition 0 SF-180 12
DD 149
Request for Medical Treatment Records DD 293 a
21-4142 i 7 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 n 21-534 5
21-22 Other q w/Accrued Benefits 0
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC - New/) 2 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) 3 10-7959a (CHAMPVA) 0
214138 (SC - Secondary/Aggravation) 1 10-7959C (CHAMPVA- Insurance Cert 0
21-4138 (SC - Reinstatement) 0
21-4138 (SC w/IU) 0 Vocational Rehabilitation
21-8940 (IU) 2 28-1900 CH 31 0
214192 (IU -Employer) 0 28-1900 (Independent Living Program) 0
214138 (SMC) 0
21-686c . 1 Educational Assistance Programs
MGIB CH 30 0
Non Service Connected Pension: VEAP CH 32 0
21-526 n VN Era GI CH 34 n
21-527 n 22-5490 CH 35 0
686c 0 Sel Reservist NG CH 1607 0
21-526/527 w/A&A 7 21-674 C
214138 (Reinstatement) 0
EVR (Any) 2 Miscellaneous Claims
21-8416 3 21-8678 (Clothing Allowance) 0
5655 1 214502 (Auto Grant/Adaptive Equipment) 0
264555 (Housing Grant) 0
Request for Waivers/Compromise: 10-0103 (HISA Grant) 0
214138 1 Medicaid Application Assistance 0
5655 (FSR) 1 SSA Application Assistance 0
Other(Specify) 0
Dependent Indemnity Compensation (INC) Other(Specify) 0
21-534 1_ Other(Specify) 0
w/Accrued Benefits 0
CVA. 2010-1826
g - 11-iD cC S‘ Corios) V Hl)l?ut
ZJ-1/9 -/D
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) 1
VA Home Loan
26-1800 4 Requests w/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 3 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 andi8ccurate. I haveebele� paid the following
amount(s)for the month of y , 20 from County:
,Salary $4,310.09
"' `Expenses None
_q A Q. ice Space -Cnu„ry p y itilities in lieu of rent
;'LL; Telephone
i 6t, A0
Office Supplies None
E.6c.( b,s Travel None
Training Conference None
Other copier 96.00
Other Internet 888q2.999
0 er Total Postage 4,624.10 + utilities
Coh
tamer
XO/O
(Signature of County Vns Service Officer) ate)
Dorothy Strong, Veterans Counselo for
Pat Persichino, Veterans Service Officer
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-70 eby
certify the accuracy of the Report(CVA-26, revised 9/1/2006):
._.F ci �,,, � /l D.,ie thy Commissioner or Designee of
Weld cCi( County County
AUG 1 1 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 9/12006)
Hello