HomeMy WebLinkAbout20091112.tiffCounty:
State of Colorado
Department of Military and Veterans Affairs
Divison of Veterans Affairs
COUNTY VETERANS SERVICE OFFICERS
MONTHLY REPORT AND CERTIFICATION OF PAY
Weld
SECTION I: GENERAL INFORMATION
Telephone Calls
111
Office (Walk-ins)
123
Home Visits
0
Outreach Visits (i.e. NH...)
0
Community Events/Forums
0
Correspondence Received
11
Correspondence Written
25
Information and Referral/Inquiries 38
ontacts: VAMC Vans
Requests for:
Military Records & Corrections
SF -180
DD 149/293
4
0
Request for Medical Treatment Records
I I
21-4142
5
Request for Medals
0
Operation Recognition
0
Request for State Benefits:
2
Request for VTF Grant Assistance I 0
Request for VA Healthcare
10-10 EZ
9
10-10 EZ-R
3
CHAMPVA
0
Miscellaneous Claims
Other (Specify)
0
Other (Specify)
0
Other (Specify)
0
Other (Specify)
0
Month of: December
, 20 OR
SECTION II: NEW CLAIMS INITIATED
Appointed Representative:
21-22
CVA
0
21-22
Other
3
Service Connected Disability Compensation
21-526 I(SC - New/)
21-4138 - Other SC (Inc, Reopen, etc) 3
13
Dependent Indemnity Compensation (DIG)
21-534
n
Non -Service Connected Pension
21-526 / 527
1
21-526/527 w/ A&A
4
Death Pension / Widows Pension
21-534
3
w/ Accrued Benefits
0
Burial Allowance
21-530
0
Vocational Rehabilitation
28-1900 / CH 31
1 1
Educational Assistance Programs
CH 30, 32, 34, 1607
CH 35
0
0
Claims for Disability Insurance
29-357 / 29-4364
0
VA Home Loan
26-1800 / 1817
7
Appeals
NOD / DRO / VA9
Q '.CI)VA Ces-LA ,7)
2
vg()co/
CVA-26 rRevised 2/1/2007)
2009-1112
Cc--I,SICO
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 December 20 08 from Weld County:
Paid In -Kind
Salary $ 4,165.34
Expenses County pay$ DAV utilities in
Utilities County pays
Office Space County
Telephone
Internet
Office Supplies
Postage
Travel
Training Conference
Other Copier
Other
TOTAL
(Signature of Count
Dorothy Strong, Veterans
Pat Persichino, Veterans
kV utilities
says
$ 88.49
$ None
$ None
$ None
in
DAV utilities
150.27
82.99
20.35
96.00
Salary $
lieppaY gs $
lieu Utilities
office
�$
inlae Telephone
rent
Internet $
Office Supplies $
Postage $
Travel $
Training Conference $
Other $
Other $
$ 4,602.44+utilities TOTAL
eteran,4 Service Offirrr
Counselor .r
Service Officer
4 lair°7
ate)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-707, I hereby certify the ac racy of the Report (CVA-26, revisQd2/1/2007):
(Signature)
County° icimmisosl er or
William F. Garcia, Chair
(Printed/Typed Name)
Weld
05/11/2009
ans Counselor
signee
County Commissioner or Designee of
County
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 2/1/2007)
2?)629---///4
State of Colorado
Department of Military and Veterans Affairs
Divison of Veterans Affairs
COUNTY VETERANS SERVICE OFFICERS
MONTHLY REPORT AND CERTIFICATION OF PAY
County: Weld
SECTION I: GENERAL INFORMATION
Telephone Calls
156
Office (Walk-ins)
117
Home Visits
0
Outreach Visits (i.e. NH...)
0
Community Events/Forums
0
Correspondence Received
19
Correspondence Written
41
Information and Referral/Inquiries 34
ontacts: vatic vans
Requests for:
Military Records & Corrections
SF -180
DD 149/293
S
0
Request for Medical Treatment Records
21-4142
4
Request for Medals
Operation Recognition
1
0
Request for State Benefits:
2
Request for VTF Grant Assistance I 0
Request for VA Healthcare
10-10 EZ
3
10-10 EZ-R
3
CHAMPVA
0
Miscellaneous Claims
Other (Specify)
0
Other (Specify)
0
Other (Specify)
9
Other (Specify)
0
Month of: .Tanuary
,2009
SECTION II: NEW CLAIMS INITIATED
Appointed Representative:
21-22
CVA
0
21-22
Other
3
Service Connected Disability Compensation
21-526 l(SC - New/)
21-4138 - Other SC (Inc, Reopen, etc)
12
21-
Dependent Indemnity Compensation (DIC)
534
0
Non -Service Connected Pension
21-526 / 527
1
21-526/527 w/ A&A
3
Death Pension / Widows Pension
21-534
3
w/ Accrued Benefits
0
Burial Allowance
21-530
Vocational Rehabilitation
28-1900 / CH 31
1
Educational Assistance Programs
CH 30, 32, 34, 1607
CH 35
0
0
Claims for Disability Insurance
29-357 / 29-4364
0
VA Home Loan
26-1800 / 1817
2
Appeals
NOD / DRO / VA9
3
CVA-26 (Revised 2/1/2007)
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 January 20 09 from Weld County:
Paid In -Kind
Salary $ 4,310.09 Salary
Expenses $ None Expenses
Utilities County pays 1$1V utilities in lieu df_ lgliftt
Office Space County rays DAV utilities in Office,. pace lieu
Telephone $ 112 56 Telephone
Internet $ 82.99 Internet
Office Supplies $ None Office Supplies
Postage $ 84.00 Postage
Travel $ None Travel
Training Conference $ None Training Conference
Other Copier $ 96.00 Other
Other $ None Other
TOTAL
$ 4,705.64+utilities TOTAL
(Signature of County t/ terans Service Offsr
Dorothy Strong, Ve erans Counselor or
Pat Persichino, Veterans SErvice Officer
$
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance wit CRS 28-5-707, I hereby certify the accr ac of the RepoyCVA-26, rev�f5ed 2/1/2007):
William F. Garcia, Chair
(Printed/Typed Name)
Weld
05/11/2009
CvS
.1_
Dorothy Strong, V erans Counselor
County Commissioner Designee
County Commissioner or Designee of
County
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 2/1/2007)
0,2ez,9_///4
County:
State of Colorado
Department of Military and Veterans Affairs
Divison of Veterans Affairs
COUNTY VETERANS SERVICE OFFICERS
MONTHLY REPORT AND CERTIFICATION OF PAY
Weld
SECTION I: GENERAL INFORMATION
Telephone Calls
187
Office (Walk-ins)
119
Home Visits
0
Outreach Visits (Le. NH...)
0
Community Events/Forums
0
Correspondence Received
36
Correspondence Written
21
Information and Referral/Inquiries 29
Contacts: VAMC Vans
Requests for:
Military Records & Corrections
SF -180
DD 149/293
7
1
Request for Medical Treatment Records
21-4142
3
Request for Medals
Operation Recognition
0
(Request for State Benefits:
7
Request for VTF Grant Assistance I 0
Request for VA Healthcare
10-10 EZ
10-10 EZ-R
CHAMPVA
3
2
0
Miscellaneous Claims
Other (Specify)
0
Other (Specify)
0
Other (Specify)
0
Other (Specify)
0
Month of: February
2009
SECTION II: NEW CLAIMS INITIATED
Appointed Representative:
21-22
CVA
0
21-22
Other
2
Service Connected Disability Compensation
21-526 I(SC - New/)
21-4138 - Other SC (Inc, Reopen, etc) 2
11
Dependent Indemnity Compensation (DIC)
534
21-
1
Non -Service Connected Pension
21-526 / 527
1
21-526/527 w/ A&A
4
Death Pension / Widows Pension
21-534
3
w/ Accrued Benefits
0
Burial Allowance
21-530
0
Vocational Rehabilitation
28-1900 / CH 31
1
Educational Assistance Programs
CH 30, 32, 34, 1607
0
CH35
0
Claims for Disability Insurance
29-357 / 29-4364
0
VA Home Loan
26-1800 / 1817
3
Appeals
NOD / DRO / VA9
2
CVA-26 (Revised 2/1/2007)
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
February 09 Weld
amount(s) for the month of , 20 from County:
Salary
Expenses
Utilities County pays V utilities
Office SpaceCounty pajs DAV utilities
Telephone $$
Paid
$ 4,310.09
$ None
q!,
133.54
Internet $ 82.99
Office Supplies $
Postage $
Travel $ None
Training Conference $ _
Other Copier $ 96.00
Other $ None
None
25.10
None
TOTAL
In -Kind
Salary $
Expenses $
in lieu Jtillitiees t� $
o peril Aleut_
gaeCer
in 1Telephonen $
Internet $
Office Supplies $
Postage $
Travel $
Training Conference $
Other $
Other $
$ 4,657.72+utilities
(Signature of Cou Veterans Service
Dorothy Strong, eterans Counso
Pat Persichino, Veterans Service
icer
for
Officer
TOTAL
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-707, I hereby certify the accu ac of the Repo
(Signature)
William F. Garcia, Chair
(Printed/Typed Name)
Weld
05/11/2009
VA -26, re,
d 2/1/2007):
Dorothy Strong, V erans Counselor
County Commissioner o esignee
County Commissioner or Designee of
County
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 2/1/2007)
&ft9- ///
County:
State of Colorado
Department of Military and Veterans Affairs
Divison of Veterans Affairs
COUNTY VETERANS SERVICE OFFICERS
MONTHLY REPORT AND CERTIFICATION OF PAY
Weld
SECTION I: GENERAL INFORMATION
Telephone Calls
212
Office (Walk-ins)
i 20
Home Visits
0
Outreach Visits (i.e. NH...)
0
Community Events/Forums
0
Correspondence Received
28
Correspondence Written
18
Information and Referral/Inquiries 41
Contacts: VAMC Van
s
Requests for:
Military Records & Corrections
SF -180
DD 149/293
6
0
Request for Medical Treatment Records
21-4142
6
Request for Medals
Operation Recognition
. 0
Request for State Benefits:
3
Request for VTF Grant Assistance I 0
Request for VA Healthcare
10-10 EZ
2
10-10 EZ-R
2
CHAMPVA
0
Miscellaneous Claims
Other (Specify)
0
Other (Specify)
0
Other (Specify)
0
Other (Specify)
0
Month of: March
, 20 09
SECTION II: NEW CLAIMS INITIATED
Appointed Representative:
21-22
CVA
0
21-22
Other
3
Service Connected Disability Compensation
13
21-526 t(SC - New/)
21-4138 - Other SC (Inc, Reopen, etc) 2
21-
Dependent Indemnity Compensation (DC)
534
0
Non -Service Connected Pension
21-526 / 527
1
21-526/527 w/ A&A
4
Death Pension / Widows Pension
21-534
3
w/ Accrued Benefits
0
Burial Allowance
21-530
0
Vocational Rehabilitation
28-1900 / CH 31
0
Educational Assistance Programs
CH 30, 32, 34, 1607
CH 35
0
0
Claims for Disability Insurance
29-357 / 29-4364
0
VA Home Loan
26-1800/1817
4
Appeals
NOD / DRO / VA9
CVA-26 (Revised 2/1/2007)
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 09 from Weld County:
Paid In -Kind
Salary
Expenses
Utilities County pays
Office Space County
Telephone
Internet
Office Supplies
Postage
Travel
Training Conference
Other Copier
Other
TOTAL
$ 4,310.09
$ None
Salary
Expenses
IiV utilities in lieuo t�ill'litie
f$ys DAV utilities inll ui Coi Ina
$ 1 7 t 23 Telephone
$ 82.99 Internet
$ None Office Supplies
$ 85.16 Postage
$ None Travel
None Training Conference
96.00 Other
Other
None
$ 4,745.47+utilities
(Signature of Countyaleterans Service Officer
Dorothy Strong, Veterans Counselor fo
Pat Persichino, Veterans Service Officer
TOTAL
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-707, I hereby certify the a racyy of the Repo VA -26, revi ail 2/1/2007):
79
(Signature)
William F. Garcia, Chair
(Printed/Typed Name)
Weld
Dorothy Strong
County Commission&l' o
erans ounselor
esignee
County Commissioner or Designee of
County
05/11/2009 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.
Mail to:
This form is to be submitted by the 15th day of the following month.
Colorado Division of Veterans Affairs
Attention: Deputy Director
7465 E. 1st Avenue, Suite C
Denver, CO 80230
CVA-26 (Revised 2/1/2007)
&?oe9_ ///�'
County:
State of Colorado
Department of Military and Veterans Affairs
Divison of Veterans Affairs
COUNTY VETERANS SERVICE OFFICERS
MONTHLY REPORT AND CERTIFICATION OF PAY
Weld
SECTION I: GENERAL INFORMATION
Telephone Calls
270
Office (Walk-ins)
164
Home Visits
0
Outreach Visits (i.e. NH...)
0
Community Events/Forums
0
Correspondence Received
32
Correspondence Written
19
Information and Referral/Inquiries 38
Contacts: V611G vans 41
Requests for:
Military Records & Corrections
SF -180
5
DD 149/293
1
Request for Medical Treatment Records
1
21-4142
4
Request for Medals
Operation Recognition
1
0
Request for State Benefits:
2
Request for VTF Grant Assistance I n
Request for VA Healthcare
10-10 EZ
2
10-10 EZ-R
2
CHAMPVA
0
Miscellaneous Claims
Other (Specify)
0
Other (Specify)
0
Other (Specify)
0
Other (Specify)
0
Month of: April
, 20 09
SECTION II: NEW CLAIMS INITIATED
Appointed Representative:
21-22
CVA
0
21-22
Other
3
Service Connected Disability Compensation
10
21-526 I(SC - New/)
21-4138 - Other SC (Inc, Reopen, etc) 3
21-
Dependent Indemnity Compensation (DIG)
534 1
0
Non -Service Connected Pension
21-526 / 527
1
21-526/527 w/ A&A
3
Death Pension / Widows Pension
21-534
w/ Accrued Benefits
4
0
Burial Allowance
21-530
1
Vocational Rehabilitation
28-1900 / CH 31
1 0
Educational Assistance Programs
CH 30, 32, 34, 1607
CH 35
0
0
Claims for Disability Insurance
29-357 / 29-4364
0
VA Home Loan
26-1800 / 1817
2
Appeals
NOD / DRO / VA9
3
CVA-26 (Revised 2/1/2007)
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 April 20 09 from Weld County:
Salary
Expenses
Paid
$ 4,310.09 Salary
$ None Expenses
Utilities County pays rSv utilities in lieu Utilities
Office SpaceCounty p
Telephone $
Internet
Office Supplies
Postage
Travel
Training Conference
Other
Other
Copier
TOTAL
a$fs DAV utilities in obirfilCetfSpracPf
lieu o en
Telephone
Internet
Office Supplies
Postage
Travel
Training Conference
Other
Other
180.20
82.99
None
21.98
None
None
96.00
None
$ 4,691.26+utilities TOTAL
(Signature of County, eterans Service Off
Dorothy Strong, Veerans Counselor or
Pat Persichino, Veterans Service Officer
In -Kind
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-707, I hereby certify the a racy of the Rep prt4CVA-26, revised 2/1/2007):
't
(Signature)
William F. Garcia, Chair
(Printed/Typed Name)
Weld
05/11/2009
County uomgisslo er�i
Zeterans Counselo
uesignee
County Commissioner or Designee of
County
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 2/1/2007)
c0 ////Z
Hello