HomeMy WebLinkAbout20070094.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS-MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of Weld Month of November, 2006
SECTION I: GENERAL INFORMATION
Telephone Calls 98 Correspondence Received 47 —
Office(Public Contacts) 112 Correspondence Written _ 20
Home Visits 0 Information and Referral/Inquiries 16
Outreach Visits(i.e. NH...) 0 Other(i.e: VCAA Notice Respone) 2
• Community Events/Forums 0 State Benefit(s) 3
Contacts/van Denver/Cheyenne 41
- Reguest for Medals 1 Request for Military Records&Corrections
Operation Recognition 0 SF-180 18
DD 149 n
Request for Medical Treatment Records DD 293 n
21-4142 I 3 NA 13075 0
Other( mAlznss ) 1
SECTON II: NEW CLAIMS INITITATED
[Provide number of new claims initiated for current reporting month]
Ap ointed Representative: Death Pension /Widows Pension
21-22 �CVA 2 21-534 0
21-22 Other 10 WI Accured Benefits 0
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC - New/) 12 10-10 EZ 1
21-4138 (SC - Informal Claim) 0 10-10 EZ-R 5
21-4138 (SC - New Issue) 8 10-583 0
21-4138 (SC - Reopen) e 10-10d (CHAMPVA- Dependents) 0
21-4138 (SC - Increase) 2_ 10-7959a (CHAMPVA) a
21-4138 (SC -Secondary/Aggravation) n 10-7959C (CHAMPVA- Insurance Cert n
21-4138 (SC - Reinstatement) 0
21-4138 (SC w/IU) 0 Vocational Rehabilitation
21-8940 (IU) 0 28-1900 CH 31 2
21-4140 (IU - Employer) 0 28-1900 (Independent Living Program) 0
21-4138 (SMC) 0
21-686c 1 Educational Assistance Programs
Nevada Test Site Questionnaire 1 MGIB CH 30 0
Non Service Connected Pension: VEAP CH 32 0
21-526 2 VN Era GI CH 34 0
21-527 0 22-5490 CH 35 1
686c 0 Sel Reservist NG CH 1606 0
21-526/527 w/A&A 0 21-674 0
21-4138(Reinstatement) 0
EVR (Any) 0 Micellaneous Claims
21-8416 2 21-8678 (Clothing Allowance) n
5655 1 21-4502 (Auto Grant I Adaptive Equipment) 0
21-0779 1 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) 21-4171 0
Dependent Indemenity Compensation (DIC) Other(Specify) 21-4170 0
21-534 1 Other(Specify) Verification/income 14
w/Accured Benefits 0 I/nOff7
CVA- 2007-0094
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SECTION II (Continued):
Burial Allowance Claims for insurance
21-530
29-357
40-1330
2 29-4364 8
21-2008 2 29-336 (Designation of Beneficiary) 9
21-4125(Claim for Lump Sum Payment) 1
VA Home Loan
26-1800 4 Requests wl VTF(Grant),#Vets Assisted
26-1817 0 Rental Assistance , 0
Utilities Assistance n
Homeless Veterans Claims Filed Prescription Assistance/Other Medical D
SC 0 Food D
NSC 0 Transportation 0
Clothing 0
Incarcerated Veterans Other p
• 214193 Release/Reinstatement 0
214138(Apportionment) 0
Appeals DRO Election
NOD n Review 0
VA 9 D 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 November , 20 06 from Weld County:
Salary S1 887 46
Expenses None
Office Space County pays utilities in lieu of rent
Telephone 169.45
Office Supplies 22.00
Travel _ None
Training Conference _ , None
OtherInternet 82,99
OtherPrinter 45.00
Postage 39.00
Total $L las qD + utilities
(Signature of County terans Service O r) (Date)
Dorothy Strong, terans Counse r for
Pat Persichino, Veterans Service Officer
SECTION IV: CERTIFICATION BY COUNTY C MMISSIONER OR DESIGNEE
In accordance with 28-5-707, I hereby certify tin accurst th VA-26, r i 91/20 ):
�� Dorothbarbo w �e ones or be gn Of
David E. Long, Chair
Weld County
ATTESTING TO BOARD OF COUNTY
COMMISSIONER SIGNATURES ONLY Tanuary 8. 2007 Date
This certification, submitt riy signed and executed, will be considered as application for the
monetary benefits to thf,`1 ffeito =�d, in accordance with 28-5-804 (2002) Colorado Revised Statue.
Lail I. y i ,a``-- . `d by the 15th day of the following month. Mail to:
ATTEST: Division of Veterans Affairs
6 `• f $tC�f �
WELD COUNTY CLERK TO H r e et:a� � Deputy Director
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/" b Y" 7 0 stAv,;nue, Suite C
BY: (c , __Aill _ :t, CO 80230 CVA-26(Revised 9/1/2006)
DEPUTY C ERK TO THE Ete •,• st ,,≥ \
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