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Home My WebLink About20090014.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 162 Office (Walk-ins) 174 Home Visits n Outreach Visits (i.e. NH...) 0 Community Events/Forums 0 Correspondence Received 34 Correspondence Written 41 Information and Referral/Inquiries 3g Contacts: VAMC Vans 36 Requests for: Military Records & Corrections SF -180 8 DD 149/293 1 Request for Medical Treatment Records I 21-4142 Request for Medals 2 Operation Recognition 0 Request for State Benefits: 2 Request for VTF Grant Assistance I 0 Request for VA Healthcare 10-10 EZ 7 10-10 EZ-R 1 CHAMPVA n Miscellaneous Claims Other(Specify)verif VA income 6 2 Other (Specify) 5655 Other (Specify) 21-8416 4 Other (Specify) vCAA Nnti cP 5 21-4125 40-1330 21-2008 CVA-18 CVA-42 1 1 1 8 8 Month of: March , 20 08 SECTION II: NEW CLAIMS INITIATED Appointed Representative: 21-22 CVA 0 21-22 Other 7 Service Connected Disability Compensation 21-526 I(SC - New/) 21-4138 - Other SC (Inc, Reopen, etc) 4 15 Dependent Indemnity Compensation (DIC) 21-534 Non -Service Connected Pension 21-526 / 527 0 21-526/527 w/ A&A 5 Death Pension / Widows Pension 21-534 1 w/ Accrued Benefits 0 Burial Allowance 21-530 Vocational Rehabilitation 28-1900 / CH 31 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 I C1_) (C«,ic 2009-0014 CVA-26 (Revised 2/1/2007) VA OOO1 of -o7 -D7 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 , 2008 from Weld County: Paid Salary $ 4.164.34 Expenses $ UtilitiesCounty pays D.%V Office SpaceCounty Telephone Internet Office Supplies Postage Travel Training Conference $ None Other Copier $ 96.00 Other None utilities in Salary Expenses lieu oOtjpi4 p$is DAV utilities in' l iCEOREW&t $ 170.19 $ 87 Q9 $ None $ 87.23 $ None TOTAL $ None Telephone Internet Office Supplies Postage Travel Training Conference Other Other In -Kind $ $ 4,600.75+utilities TOTAL $ (Signature of County veterans Service Off Dorothy Strong, Ve'L/erans Counselor for Pat Persichino, Veterans Service Officer 17-23-08 (Date) SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE In accordance rt' CRS 28-5-707, I hereby certify the cc racy of the Repprt (CVA-2G; ire sed 2/1/2007): C719i (Signature) William F. Garcia (Printed/Typed Name) Weld JAN 0 5 2302 Dorothy Strong, Ve erans Counselor County Commissions or 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) 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 151 Office (Walk-ins) 168 Home Visits 0 Outreach Visits (i.e. NH...) 0 Community Events/Forums n Correspondence Received 28 Correspondence Written 43 Information and Referral/Inquiries 32 ontacts: VAM(. c Requests for: Military Records & Corrections SF -180 10 DD 149/293 1 Request for Medical Treatment Records 21-4142 6 Request for Medals 2 Operation Recognition 0 Request for State Benefits: 3 Request for VTF Grant Assistance I 0 Request for VA Healthcare 10-10 EZ 1 10-10 EZ-R 1 CHAMPVA 0 Miscellaneous Claims Other (Specify)Verif. VA incone 8 Other (Specify) 5655 1 Other (Specify) 21-8416 3 Other (Specify)VCAA Notice 8 21-4125 40-1330 21-2008 CVA-18 CVA-42 0 0 7 7 Month of: April 2008 SECTION II: NEW CLAIMS INITIATED Appointed Representative: 21-22 CVA 0 21-22 Other 8 Service Connected Disability Compensation 21-526 I(SC - New/) 21-4138 - Other SC (Inc, Reopen, etc) 13 Dependent Indemnity Compensation (DIC) 21-534 2 Non -Service Connected Pension 21-526 / 527 0 21-526/527 w/ A&A 4 Death Pension / Widows Pension 21-534 2 w/ Accrued Benefits 0 Burial Allowance 21-530 0 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 0 Appeals NOD / DRO / VA9 G CVA-26 (Revised 2/1/2007) In accordance wi (Signature) SECTION III: CERTIFICATION BY COUNTY VETERANS SERVICE OFFICER I hereby certify, the above captioned monthly report is true and accurate. amount(s) for the month of April 2008 from _ I have been paid the following Weld County: Paid In -Kind Salary $ 4,164.34 Expenses $ None Salary Expenses ounty pays utilities in lieu of rent Utilities Utlhtounty pays util ties DAV in lieu of r Office Space o Rice Space Telephone $ 167 21 Internet 82.99 Office Supplies Postage 10 Travel Training Conference Other Copier 96 00 Other None None None 75 TOTAL I' None Telephone Internet Office Supplies Postage Travel Training Conference Other Other $ 4,515.79+utilities TOTAL (Signature of County - terans Service Officer Dorothy Strong, Veterans Counselor for Pat Persichino, Veterans Service Officer 12-23-08 (Date) SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE RS 28-5-707, I hereby certify the ac uracy of the Report (CVA-26, ry d 2/1/2007): l William F. Garcia (Printed/Typed Name) Weld JAN 0 5 zing CouFn`iy99Aniisslo y JruesigneCounsel 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) 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 173 Office (Walk-ins) 182 Home Visits 0 Outreach Visits (i.e. NH...) 0 Community Events/Forums 0 Correspondence Received 31 Correspondence Written 29 Information and Referral/Inquiries 32 Contacts: VAMC Vans 38 Requests for: Military Records & Corrections SF -180 7 DD 149/293 Request for Medical Treatment Records 21-4142 8 Request for Medals 3 Operation Recognition 0 Request for State Benefits: Request for VTF Grant Assistance I 0 Request for VA Healthcare 10-10 EZ 2 10-10 EZ-R 1 CHAMPVA 0 Miscellaneous Claims Other (Specify) Verif. of VA iponme 7 3 Other (Specify) 5655 Other (Specify) 21-8416 5 Other (Specify) VCAA Notice 10 L1-41 LJ 40-1330 21-2008 CVA-18 CVA-42 0 0 6 6 Month of: May ,20n8 SECTION II: NEW CLAIMS INITIATED Appointed Representative: 21-22 CVA 1 21-22 Other 6 Service Connected Disability Compensation 21-526 I(SC - New/) I 14 21-4138 - Other SC (Inc, Reopen, etc) 2 Dependent Indemnity Compensation (DIC) 21-534 0 Non -Service Connected Pension 21-526 / 527 0 21-526/527 w/ A&A 6 Death Pension / Widows Pension 21-534 0 w/ Accrued Benefits 0 Burial Allowance 21-530 Vocational Rehabilitation 28-1900 / CH 31 Educational Assistance Programs CH 30, 32, 34, 1607 CH 35 0 0 Claims for Disability Insurance 29-357 / 29-4364 1 VA Home Loan 26-1800 / 1817 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 amount(s) for the month of May , 20 08 from Weld County: Salary Expenses Utilities County pays Office Si92tINY Telephone Internet Office Supplies Postage Travel Training Conference Dues Other Other TOTAL Paid $ 4,164.34 $ None D�V utilities in lieu o ren pays DV utilities_in lieu or-ren $ 162 21 $ 82.99 $ None $ 6 19 $ 56.26 $ Copier $ 96.00 450.00 40.00 Salary Expenses Utilities Office Space Telephone Internet Office Supplies Postage Travel Training Conference Other Other $ 5,057.99+utilities TOTAL 11.:3 Cy/LG iL (Signature of Coui4/y Veterans Servic: officer Dorothy Strong, Veterans Counselor for Pat Persichino, Veterans Service Officer In -Kind 12-23-08 (Date) SECTION IV: CERTIFICATION BY COUY COMMISSIONER O DESIGNEE In accordance with S 28-5-707, I hereby certify the ac uracy of th�port (CV `?O, revised 2/1/2007): rj Dorothy Strong, try eterans Couns County Commissio fer or Designee (Signature) William F. Garcia (Printed/Typed Name) Weld JAN 0 5 2009 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) 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 184 Office (Walk-ins) 193 Home Visits 0 Outreach Visits (i.e. NH...) 0 Community Events/Forums 0 Correspondence Received 42 Correspondence Written 31 Information and Referral/Inquiries 34 Requests for: Military Records & Corrections SF -180 10 DD 149/293 0 Request for Medical Treatment Records 21-4142 7 Request for Medals 2 Operation Recognition n Request for State Benefits: 3 Request for VTF Grant Assistance I 0 Request for VA Healthcare 10-10 EZ 3 10-10 EZ-R 1 CHAMPVA 0 Miscellaneous Claims Other(Specify)1f VA Tncona 10 2 Other (Specify) 5655 Other (Specify) 21-8416 4 Other (Specify) VCAA Notice 9 G1-41LJ 40-1330 21-2008 CVA-18 CVA-42 0 0 6 5 Month of: .bins ,20n8 SECTION II: NEW CLAIMS INITIATED Appointed Representative: 21-22 CVA n 21-22 Other 7 Service Connected Disability Compensation 21-526 I(SC - New/) 21-4138 - Other SC (Inc, Reopen, etc) 4 116 Dependent Indemnity Compensation (DIC) 21-534 1 Non -Service Connected Pension 21-526 / 527 1 21-526/527 w/ A&A 5 Death Pension / Widows Pension 21-534 w/ Accrued Benefits 0 Burial Allowance 21-530 0 Vocational Rehabilitation 28-1900 / CH 31 0 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 0 Appeals NOD / DRO / VA9 1 CVA-26 (Revised 2/1/2007) Telephone Internet Office Supplies Postage Travel Training Conference Copier Other Other TOTAL 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 20 08 from Weld County: Paid Salary $ 4,164.34 Salary Expenses $ None Expenses County pays AV utilities in lieu Utilities J orf rent Utilities Office SpIWnty pays$DAVoMttrcnties in lieuOffice Space $ 118 t q Telephone $ 82.99 Internet None 80.00 None None 96.00 None $ 4,561.52+utilities (Signature of Co y Veterans Servicecer Dorothy Strong, terans Counselo for Pat Persichino, Veterans Service Officer In -Kind $ Office Supplies $ Postage $ Travel $ Training Conference $ Other $ Other $ TOTAL 12-23-08 SECTION IV: CERTIFICATION BY COUNTY COMMISSION In accordance w (Signature) CRS 28-5-707, I hereby certify the William F. Garcia (Printed/Typed Name) Weld JAN 0 5 2009 (Date) R OR DESI NEE acji of the ep (CVA-26 2/1/2007): nselor Dorothy Strong, Vets ans Cou County Commissioner dr 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) 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 171 Office (Walk-ins) 189 Home Visits 0 Outreach Visits (i.e. NH...) 0 Community Events/Forums 0 Correspondence Received 36 Correspondence Written 37 Information and Referral/Inquiries ..3Z Contacts: VAMC Vans 29 Requests for: Military Records & Corrections SF -180 9 DD 149/293 0 Request for Medical Treatment Records 6 21-4142 Request for Medals Operation Recognition I 0 Request for State Benefits: 2 Request for VTF Grant Assistance I 0 Request for VA Healthcare 10-10 EZ 2 10-10 EZ-R 1 CHAMPVA 0 Miscellaneous Claims Other (Specify) Veri f VA 1 ncot e 9 Other (Specify) 5655 1 Other (Specify) 21-8416 7 Other (Specify) VCAA Notice 10 40-1330 21-2008 CVA-18 CVA-42 0 0 6 6 Month of: .lnly ,2008 SECTION II: NEW CLAIMS INITIATED Appointed Representative: 21-22 CVA 0 21-22 Other 6 Service Connected Disability Compensation 21-526 I(SC - Newt) 112 21-4138 - Other SC (Inc, Reopen, etc) 5 Dependent Indemnity Compensation (DIC) 21-534 0 Non -Service Connected Pension 21-526 / 527 1 21-526/527 w/ A&A 4 Death Pension / Widows Pension 21-534 0 w/ Accrued Benefits 0 Burial Allowance 21-530 7 Vocational Rehabilitation 28-1900 / CH 31 Educational Assistance Programs CH 30, 32, 34, 1607 CH 35 0 U Claims for Disability Insurance 29-357 / 29-4364 0 VA Home Loan 26-1800 / 1817 1 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 amount(s) for the month of July , 20 08 from Weld County: Paid Salary $ 4,164.34 ExpensesCounty pays$DAy utilitiesnt in ieu o re Utilities County pays D$1V utilities in $R--'1T� rent Office Spacetounty a�� DAY ui il±ties in Telephone 1pie o ren $165.56 Internet Office Supplies Postage Travel Training Conference Other copier Other TOTAL 82.99 135.23 8.29 None None 96.00 None In -Kind Salary $ Expenses $ Utilities $ Office Space $ Telephone $ Internet $ Office Supplies $ Postage $ Travel $ Training Conference $ Other $ Other $ $ 4,652.41+utilities TOTAL (Signature ofCoun/ Veterans Service O er Dorothy Strong, Veterans Couny- or for Pat Persichino, Veterans Service Officer 12-23-08 (Date) SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE In accordance with. S 28-5-707, I hereby certify the �cc�uracy of th R rt (CVA\2ised 2/1/2007): (Signature) William F. Garcia (Printed/Typed Name) Weld JAN 0 5 2369 IYorUthy Strong, County Commission At terans Counse or 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 2O/2007) 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 201 Office (Walk-ins) 174 Home Visits 0 Outreach Visits (i.e. NH...) 0 Community Events/Forums 0 Correspondence Received 34 Correspondence Written 29 Information and Referral/Inquiries 31 Requests for: Military Records & Corrections SF -180 8 DD 149/293 0 Request for Medical Treatment Records 21-4142 4 Request for Medals 2 Operation Recognition 0 Request for State Benefits: 3 Request for VTF Grant Assistance I 0 Request for VA Healthcare 10-10 EZ 4 10-10 EZ-R 2 CHAMPVA 0 Miscellaneous Claims Other (Specify) Verif. of VA _nc^m.' 7 Other (Specify) 5655 3 Other (Specify) 21-8416 8 Other (Specify) VCAA Notice 10 L1-41 LJ 40-1330 21-2008 CVA-18 CVA-42 0 0 5 4 Month of: Angus t , 20 Os SECTION II: NEW CLAIMS INITIATED Appointed Representative: 21-22 CVA 0 21-22 Other 5 Service Connected Disability Compensation 21-526 I(SC - New/) 21-4138 - Other SC (Inc, Reopen, etc) 4 9 Dependent Indemnity Compensation (DIC) 21-534 0 Non -Service Connected Pension 21-526 / 527 0 21-526/527 w/ A&A 5 Death Pension / Widows Pension 21-534 0 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 0 Appeals NOD / DRO I 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 August , 20 08 from Weld County: Salary Expenses Utilities County pays Office Space County Telephone Internet Office Supplies Postage Travel Training Conference Other Copier Other TOTAL Paid $ 4,164.34 $ None DAV utilit es it ppieu o ren P�Ys lieuutrlrent $ 156 19 $ 82.99 $ None $ 7.14 $ None $ None $ 96.00 $ None Salary Expenses Utilities in Office Space Telephone Internet Office Supplies Postage Travel Training Conference Other Other $ 4, 504.86+utilities TOTAL (Signature of Count eterans Service .j icer Dorothy Strong, Ve -rans Counselo for Pat Persichino, Veterans Service Officer SECTION IV: CERTIFICATION BY COUNT In accordance with CRS 28-5-707, I hereby certify the ac (Signature) William F. Garcia (Printed/Typed Name) Weld JAN 0520d In -Kind $ 12-23-08 (Date) OMMISSIONER OR DESIGNEE uyacy of the rt (CVA-2 r ised 2/1/2007): Dorothy Strong, eterar(s Counse County Commission or 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. 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) 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 159 Office (Walk-ins) 167 Home Visits 0 Outreach Visits (i.e. NH...) 0 Community Events/Forums 0 Correspondence Received 32 Correspondence Written 36 Information and Referral/Inquiries 39 acts: VAMC vans 31 Requests for: Military Records & Corrections SF -180 9 DD 149/293 1 Request for Medical Treatment Records 21-4142 5 Request for Medals 3 Operation Recognition 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 1 CHAMPVA 0 Miscellaneous Claims Other (Specify) Verif. VA incor!e 8 Other (Specify) 5655 2 Other (Specify) 21-8416 7 Other (Specify) VCAA Notice 9 G1-91GJ 40-1330 21-2008 CVA-18 CVA-42 0 0 7 6 Month of: September , 20 nR SECTION II: NEW CLAIMS INITIATED Appointed Representative: 21-22 CVA n 21-22 Other 5 Service Connected Disability Compensation 21-526 I(SC - New/) 21-4138 - Other SC (Inc, Reopen, etc) 5 7 Dependent Indemnity Compensation (DIC) 21-534 1 Non -Service Connected Pension 21-526 / 527 0 21-526/527 w/ A&A 4 Death Pension / Widows Pension 21-534 w/ Accrued Benefits 0 Burial Allowance 21-530 1 Vocational Rehabilitation 28-1900 / CH 31 0 Educational Assistance Programs CH 30, 32, 34, 1607 0 CH 35 0 Claims for Disability Insurance 29-357 / 29-4364 0 VA Home Loan 26-1800 / 1817 2 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 amount(s) for the month of September , 20 08 from Weld County: Paid Salary $ 4,164.34 Expenses $ None Cmh.j ays DAV utilies in lieu of rent Cd fttI ays DAV utilities in lieu of rent Office Space $ Telephone $ 158 79 Internet $ 82.99 Office Supplies $ None Postage $ 21 50 Travel $ None Training Conference $ None Other Copier $ 96 00 Other TOIL $ None $4,585 6?+nrilities 1/I ? Salary Expenses Utilities Office Space Telephone Internet Office Supplies Postage Travel Training Conference Other Other (Signature of County V terans Service Offi Dorothy Strong, Veter s Counselor fo Pat Persichino, Veterans Service Officer TOTAL SECTION IV: CERTIFICATION BY COUNT In accordance with CRS 28-5-707, I hereby certify the a In -Kind 12-23-08 (Date) OMMISSIONER OR D acy of th e ort{G itAti SIGNEE vised 2/1/2007): orothy Strong, Vetera'hs Couns County Commissiorti r or Designee (Signature) William F. Garcia (Printed/Typed Name) Wald JAN 0 5 LA 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) 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 174 Office (Walk-ins) 182 Home Visits 0 Outreach Visits (i.e. NH...) 0 Community Events/Forums 0 Correspondence Received 31 Correspondence Written 34 Information and Referral/Inquiries 35 ontacts: VAMC van Requests for: Military Records & Corrections SF -180 8 0 DD 149/293 Request for Medical Treatment Records 21-4142 6 Request for Medals 2 Operation Recognition 0 Request for State Benefits: 2 Request for VTF Grant Assistance 0 Request for VA Healthcare 10-10 EZ 4 10-10 EZ-R 2 CHAMPVA 0 Miscellaneous Claims Other (Specify) Verif. of VA income 6 Other (Specify) 5655 4 Other (Specify) 21-8416 6 Other (Specify)1cAA Notice 9 21-4125 40-1330 21-2008 CVA-18 CVA-42 0 1 1 7 6 Month of: October , 20 08 SECTION II: NEW CLAIMS INITIATED Appointed Representative: 21-22 CVA 0 21-22 Other 6 Service Connected Disability Compensation 21-526 I(SC - New/) 21-4138 - Other SC (Inc, Reopen, etc) 5 6 Dependent Indemnity Compensation (DIC) 21-534 n Non -Service Connected Pension 21-526 / 527 0 21-526/527 w/ A&A 5 Death Pension / Widows Pension 21-534 0 w/ Accrued Benefits 0 Burial Allowance 21-530 n Vocational Rehabilitation 28-1900 / CH 31 0 Educational Assistance Programs CH 30, 32, 34, 1607 CH 35 n 0 Claims for Disability Insurance 29-357 / 29-4364 0 VA Home Loan 26-1800 / 1817 0 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 October 20 n8 from - Weld County: Paid Salary $ 4,164.34 Salary Expenses $ None Expenses Utilities..County pays DAV tilities in lieu of 'Mites ou t Days DAV u illrles In lieu of r Vr..Ce Space Office b aOe P Telephone Internet Office Supplies Postage Travel Training Conference $ None Other Copier $ 96.00 Other $ 167 52 $ 82.99 $ None $ 6,23 $ None TOTAL $ None $ 4,517.08+utilities (Signature of Count,/J✓eterans Service j cer Dorothy Strong, Veterans Counselo for Pat Persichino, Veterans Service Officer In -Kind Telephone Internet Office Supplies Postage Travel Training Conference Other Other TOTAL 12-23-08 (Date) SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER O In accordance w (Signature) S 28-5-707, I hereby certify William F. Garcia Uoro h Stron ounty uommis o (Printed/Typed Name) Weld JtiN iU h J<1 curacy of thq ijeport (CV C ;t11� DESIGNEE 6 revised 2/1/2007): Veterans Counse er or 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) 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 162 Office (Walk-ins) 178 Home Visits 0 Outreach Visits (i.e. NH...) 0 Community Events/Forums 0 Correspondence Received 47 Correspondence Written 29 Information and Referral/Inquiries 31 ontacts: van Requests for: Military Records & Corrections SF -180 DD 149/293 7 0 Request for Medical Treatment Records 21-4142 I I 5 Request for Medals 4 Operation Recognition 0 Request for State Benefits: 3 Request for VTF Grant Assistance 0 Request for VA Healthcare 10-10 EZ 3 10-10 EZ-R 0 CHAMPVA 1 Miscellaneous Claims Other (Specify) Verif. of VA income 8 Other (Specify) 5655 3 Other (Specify) 21-8v,16 6 Other(Specify) VCAA Notice 9 21-4125 40-1330 21-2008 CVA-18 CVA-42 0 0 0 8 7 Month of: November ,20 oR SECTION II: NEW CLAIMS INITIATED Appointed Representative: 21-22 CVA 0 21-22 Other 5 Service Connected Disability Compensation 21-526 1(SC - New/) 21-4138 - Other SC (Inc, Reopen, etc) 6 8 Dependent Indemnity Compensation (DIC) 21-534 1 Non -Service Connected Pension 21-526 / 527 0 21-526/527 w/ A&A 5 Death Pension / Widows Pension 21-534 1 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 n 0 Claims for Disability Insurance 29-357 / 29-4364 0 VA Home Loan 26-1800 / 1817 n Appeals NOD / DRO / VA9 0 CVA-26 (Revised 2/1/2007) $ 4,561.15+utilities 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 November , 2CPB from Weld County: Paid In -Kind Salary $ 4,164.34 Expenses $ None ou a s DAV utilit' s in lieu of rent ou to s DAV utilitis in lieu of rent O ice Space Telephone $ 179 as Internet $ 82.99 Office Supplies $ None Postage $ 45 34 Travel $ None Training Conference $ None Other Copier $ 96 00 Other $ None TOTAL f (Signature of Cojihty Veterans Servic Dorothy Strong, eterans Counse Pat Persichino, Veterans Service Salary Expenses Utilities Office Space Telephone Internet Office Supplies Postage Travel Training Conference Other Other fficer for Officer TOTAL SECTION IV: CERTIFICATION BY COUNTY In accordance w_ CRS 28-5-707, I hereby certify the acc (Signature) William F. Garcia (Printed/Typed Name) Weld 12-23-08 (Date) OMMISSIONER OR DESI yofthe Re•o' r VA -26;.= Dorothy Strong, County Commissioner NEE 2/1/2007) terans Counselor 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. 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) Hello