HomeMy WebLinkAbout20092805.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
348
Office (Walk-ins)
132
Home Visits
0
Outreach Visits (i.e. NH...)
1
Community Events/Forums
0
Correspondence Received
24
Correspondence Written
41
Information and Referral/Inquiries 29
ontacts: VAMC Vans
Requests for:
Military Records & Corrections
SF -180
9
DD 149/293
2
Request for Medical Treatment Records
21-4142
5
Request for Medals
1
Operation Recognition
0
Request for State Benefits:
1
[Request for VTF Grant Assistance
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)
0
Other (Specify)
0
Month of: May
,20 0.9
SECTION II: NEW CLAIMS INITIATED
Appointed Representative:
21-22
CVA
0
21-22
Other
5
Service Connected Disability Compensation
21-526
21-4138 - Other SC (Inc, Reopen, etc) 6
(SC - New/)
12
Dependent Indemnity Compensation (DIC)
21-534
0
Non -Service Connected Pension
21-526 / 527
1
21-526/527 w/ A&A
3
Death Pension / Widows Pension
21-534
5
w/ Accrued Benefits
0
Burial Allowance
21-530
2
Vocational Rehabilitation
28-1900 / CH 31
Educational Assistance Programs
CH 30, 32, 34, 1607
0
CH 35
0
Claims for Disability Insurance
29-357 / 29-4364
U
VA Home Loan
26-18001 1817
4
Appeals
NOD / DRO / VA9
4
2009-2805
/044,70,7
///a-Voq
11/1 OC.C /
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 09 from Weld County:
Paid In -Kind
Salary
EXpenCo ny pays
a s
Utilities
Office sisge6y pays utilities in lieu
Telephone $ 272.05
Internet $ 82.99
Office Supplies
Postage
Travel
Training Conference
Other Copier $ 96.00
Other Dues $ 40.00
$ 4,310.09
$ None
ut}rlities _
Salary
Expenses
in lieu of rent.tll-ties
None
22.08
57.23
TOTAL
53a 00
of re,f{ice Space
Telephone
Internet
Office Supplies
Postage
Travel
Training Conference
Other
Other
5,314.44+utilities
(Signature of County eterans Service Officer
Dorothy Strong, Ve 7•rans Counselor fo
Pat Persichino, Veterans Service Officer
TOTAL
SECTION IV: CERTIFICATION BY COUNTY CO
In accordance with CRS 28-5-707, I hereby certify the accur
(Signature)
William F. Garcia, Chair
(Printed/Typed Name)
Weld
OCT 2 F 2009
$
/O -/8-O
(Date)
ISSIONER OR DESIG
e Report
02 it)
Do o y Strong, V
County Commissioner or
E
1/2007):
erans 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.
Mail to
This form is to be submitted by the 15th day of the following month.
Co/orado Division of Veterans Affairs
Attention: Deputy Director
7465 E. 1st Avenue, Suite C
Denver, CO 80230
CVA-26 (Revised 2/1/2007)
&G'D9- ad"i
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)
143
Home Visits
0
Outreach Visits (i.e. NH...)
0
Community Events/Forums
0
Correspondence Received
28
Correspondence Written
38
Information and Referral/Inquiries 30
Contacts: VAMC Vans
58
Requests for:
Military Records & Corrections
SF -180
11
DD 149/293
1
Request for Medical Treatment Records
21-4142
4
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
2
10-10 EZ-R
4
CHAMPVA
1
Miscellaneous Claims
Other (Specify)
0
Other (Specify)
0
Other (Specify)
0
Other (Specify)
0
Month of:
June , 2009
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) 5
I 14
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
4
w/ Accrued Benefits
0
Burial Allowance
21-530
3
Vocational Rehabilitation
28-1900 / CH 31
o
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
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 June 20 09 from Weld County:
Paid In -Kind
Salary
Expenses
Utilities County
Office Sg gty
Telephone
Internet
Office Supplies
Postage
Travel
Training Conference
Other Copier
Other
TOTAL
$ 4,310.09
$ None
pays tl$ilities in lieu
pays u ilities in lieu
$ 304.48
$ 14.40
82.99
None
$
$ 96.00
$ None
None
None
Salary
Expenses
of rkittlities
of r®aKice Space
Telephone
Internet
Office Supplies
Postage
Travel
Training Conference
Other
Other
$4,807.96+utilities
TOTAL
$
/O /?-C t
(Signature of County : terans Service Officer •(Date)
Dorothy Strong, Veterans
Pat Persichino, Veterans
Counselor for
Service Officer
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIG E
In accordance with CRS 28-5-707, I hereby certify the ac u racy of the Report ( 1A-26, revi /1/2007):
(Signature)
William F. Garcia, Chair
(Printed/Typed Name)
Weld
OCT 2 6 2009
Dorothy Strong, Ve
County Commissioner or
Trans 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)
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
1R4
Office (Walk-ins)
165
Home Visits
0
Outreach Visits (Le. NH...)
0
Community Events/Forums
0
Correspondence Received
35
Correspondence Written
41
Information and Referral/Inquiries 35
Contacts: VAMC vans
Requests for:
Military Records & Corrections
SF -180
10:
DD 149/293
2
61
Request for Medical Treatment Records
21-4142
3
Request for Medals
3
Operation Recognition
0
Request for State Benefits:
1
Request for VTF Grant Assistance
0
Request for VA Healthcare
10-10 EZ
1
10-10 EZ-R
3
CHAMPVA
0
Miscellaneous Claims
Other (Specify)
0
Other (Specify)
0
Other (Specify)
0
Other (Specify)
0
Month of: July
, 2009
SECTION II: NEW CLAIMS INITIATED
Appointed Representative:
21-22
CVA
2
21-22
Other
4
Service Connected Disability Compensation
21-526 f(SC - New/)
21-4138 - Other SC (Inc, Reopen, etc) 7
I 13
Dependent Indemnity Compensation (DIC)
21-534
0
Non -Service Connected Pension
21-526. / 527
2
21-526/527 w/ A&A
5
Death Pension / Widows Pension
21-534
3
w/ Accrued Benefits
0
Burial Allowance
21-530
2
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
2
Appeals
NOD / DRO / VA9
0
CVA-26 (Revised 2/1/2007)
$ Nnnp
$ None
$ None
In accordance with CRS 28-5-707, I hereby certify the c urtccy�of the Re Art (C
Dorothy Strong, Ve
(Signature)
William F. Garcia, Chair
(Printed/Typed Name)
Weld
OCT 2 5 2009
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 09 from Weld County:
Paid In -Kind
Salary
Expenses
UtllitiesCounty pays ut$ilities in lieu
Office SpaceCounty pas utilities in
Telephone $ 346.51
Internet $ 82.99
Office Supplies
Postage $ 16.98
Travel
Training Conference
Copier $ 96.00
$ 4,310.09
$ None
Other
Other
$ None
TOTAL $ 4,852.57
AJ
Salary $
Expenses $
of reth.hulities $
lieuCAfitel3pace $
Telephone $
Internet $
Office Supplies $
Postage $
Travel $
Training Conference $
Other $
Other - $
+utilitiesTOTAL
(Signature of County VVerans Service Officer
Dorothy Strong, Veterans Counselor for
Pat Persichino, Veterans Service Officer
/0 -/9-c
(Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR ? DE IGNEE
-25-yised 2/1/2007):
ans Counselor
County Commissioner 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)
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
198
Office (Walk-ins)
130
Home Visits
1
Outreach Visits (i.e. NH...)
0
Community Events/Forums
0
Correspondence Received
28
Correspondence Written
31
Information and Referral/Inquiries 42
Contacts: VAMC Vans
59
Requests for:
Military Records & Corrections
SF -180
7
DD 149/293
2
Request for Medical Treatment Records
21-4142
I 1 5
Request for Medals
Operation Recognition
3
0
Request for State Benefits:
1
Request for VTF Grant Assistance
0
Request for VA Healthcare
10-10 EZ
2
10-10 EZ-R
4
CHAMPVA
0
Miscellaneous Claims
Other (Specify)
n
Other (Specify)
0
Other (Specify)
0
Other (Specify)
0
Month of: August , 2009
SECTION II: NEW CLAIMS INITIATED
Appointed Representative:
21-22
CVA
n
21-22
Other
4
Service Connected Disability Compensation
21-526 1(SC - New/)
21-4138 - Other SC (Inc, Reopen, etc) 5
I 10
Dependent Indemnity Compensation (DIC)
21-534
0
Non -Service Connected Pension
21-526 / 527
1
21-526/527 w/ A&A
3
Death Pension / Widows Pension
21-534
4
w/ Accrued Benefits
0
Burial Allowance
21-530
2
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
2
Appeals
NOD / DRO / VA9
4
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
for the month of August 20 09 from Weld
amount(s)County:
Paid
Salary $4, 310.09 Salary
Expenses $None Expenses
Utilities County pays u$ilities in lieu of reWtilities
Office S my pays $tilities in liou of r€xThce Space
$ 361.03 Telephone
$ 82.99 Internet
Office Supplies
$ 23.94 Postage
$None
$None
$ 96.00
$None
Telephone
Internet
Office Supplies
Postage
Travel
Training Conference
Other Copier
Other
TOTAL
�l
$None
$ 4,874.05+utilities
(Signature of Co Veterans Service
Dorothy Strong, UVeterans Counsel
Pat Persichino, Veterans Service
fficer
'r for
Officer
Travel
Training Conference
Other
Other
TOTAL
In -Kind
c2G, ,?6G y
(Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-707, I hereby certify the accucy of the Rep 9ry ( A-26, rev ) 2/1/2007):
orTt�hy. Strong,`
County Commissioner or,
(Signature)
William F. Garcia, Chair
(Pnnted/ryped Name)
Weld
OCT 2 62009
terans Counselo
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)
aae9-a49o5
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
216
Office (Walk-ins)
141
Home Visits
0
Outreach Visits (i.e. NH...)
0
Community Events/Forums
0
Correspondence Received
32
Correspondence Written
29
Information and Referral/Inquiries 35
Contacts: VAMC vans
63
Requests for:
Military Records & Corrections
SF -180
DD 149/293
8
1
Request for Medical Treatment Records
21-4142 I 4
Request for Medals
2
Operation Recognition
0
Request for State Benefits:
Request for VTF Grant Assistance
0
Request for VA Healthcare
10-10 EZ
10-10 EZ-R
CHAMPVA
2
5
0
Miscellaneous Claims
Other (Specify)
0
Other (Specify)
0
Other (Specify)
0
Other (Specify)
0
Month of:
September , 2009
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) 4
11
Dependent Indemnity Compensation (DIC)
21-534
0
Non -Service Connected Pension
21-526 / 527
1
21-526/527 w/ A&A
2
Death Pension / Widows Pension
21-534
4
w/ Accrued Benefits
0
Burial Allowance
21-530
3
28-1900 / CH 31 I 0 J
Vocational Rehabilitation
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
3
Appeals
NOD / DRO / VA9
5
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 09 from Weld
County:
Paid
Salary $ 4,310.09
Expenses $ None
County pays utilities in lieu of
Utlhtl county pays utilities ill lieu of
Office Space $
Telephone $ 410.92
Internet
Office Supplies
Postage $ 19.34
Travel
Training Conference
Other Copier $ 96.00
Other
$ 82.99
$ None
TOTAL
(Signature of Count
Dorothy Strong,
Pat Persichino, Veterans Service Officer
Veterans
Counselor for
$ None
$ None
$ None
Salary
Expenses
rent Utilities
rent
Office Space
Telephone
Internet
Office Supplies
Postage
Travel
Training Conference
Other
Other
$ 4,919.39+utilities
eterans Service Oer
TOTAL
SECTION IV: CERTIFICATION BY COUN
In accordance with CRS 28-5-707, I hereby certify the
In -Kind
(Date)
COMMISSIONER OR DESIGNEE
cy of the Reps. ; (CV:- - fed 2/1/2007):
Dorot Strong,. Vet ans Counselor
County Commissione . Designee
(Signature)
William F. Garcia, Chair
(Printed/Typed Name)
Weld
OCT 2 6 2009
County
Date
County Commissioner or Designee of
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)
00099- acfD5
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