HomeMy WebLinkAbout20070571.tiff 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 Month of: December 20 06
SECTION I: GENERAL INFORMATION SECTION II: NEW CLAIMS INITIATED
Telephone Calls 229 Appointed Representative:
Office (Walk-ins) 139 21-22 CVA 0
Home Visits 0 21-22 Other 9
Outreach Visits (i.e. NH...) 0
Community Events/Forums 0 Service Connected Disability Compensation
Correspondence Received 51 21-526 I(SC - New/) I 9
Correspondence Written 38 j21-4138 - Other SC (Inc, Reopen, etc)q
Information and Referral/Inquiries 40
Contacts: VAMC Vans 50 Dependent Indemnity Compensation (DIC)
Requests for: 21-534 I 1
Military Records & Corrections
SF-180 in Non-Service Connected Pension
DD 149/293 1 21-526 / 527
9
21-526/527 w/A&A 1
Request for Medical Treatment Records
21-4142 I I I 4 Death Pension /Widows Pension
21-534 2
Request for Medals 2 w/Accrued Benefits 0
Operation Recognition 0
Burial Allowance
Request for State Benefits: 1 21-530 I 2
Request for VTF Grant Assistance 0 Vocational Rehabilitation
28-1900 / CH 31 I 2
Request for VA Healthcare
10-10 EZ 4 Educational Assistance Programs
10-10 EZ-R 0 CH 30, 32, 34, 1607 0
CHAMPVA 0 CH 35 0
Miscellaneous Claims Claims for Disability Insurance
Other (Specify) 21-4125 3 29-357 / 29-4364 I 0
Other (Specify) Verif. of incomel2
Other (Specify) 5655 1 VA Home Loan
Other (Specify) 21-8416 5 26-1800 / 1817 I 11
VCAA Notice 1
40-1330 1 Appeals
21-2008 1 NOD / DRO / VA9 I 2
2007-0571
CVA-cu 1nav,acu u o�..�,
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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 04, from Weld County:
Paid In-Kind
Salary $ 3.887.46 Salary $
Expenses $ None Expenses $
Utilities $ County pays in lieu Utilities $
Office Space $ Nn,,,, of rent Office Space $
Telephone $ 170.31 Telephone $
Internet $ 82.99 Internet $
Office Supplies $ None Office Supplies $
Postage $ 18.39 Postage $
Travel $ None Travel $
Training Conference $ None Training Conference $
Other Copier $ 45.00 Other $ _
Other $ None Other $
TOTAL $ 4,204. 15 +utilities TOTAL $
/
4 .- ^ 3. .� -_ ,,_ - ,->2 / -C 7
(Signature of County Vens Service Officer (Date)
Dorothy Strong, Veter ns Counselor fo
Pat Persichino, Veterans Service Officer
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-707, I hereby certify th a uracy of the Report(CVA-26, revised 2/1/2007):
ri
Dorothy Strong, Veter ns Counselor
c 1 County Commissi I er or Designee
(Signature)
David E. Lon2, Chair County Corn 'at eroi,' nee of
(Printed/Typed Name) .4.g.;r7 <_ ifi i !1
caela County U 'E 6COUNTt'eL'ERh( 0 THE B
� �
01/04/2007 Date r6:ERu rEala 6A4Wid3iRTY
COMMISSIONER SIGNATURES ONLY
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
a COUNTY VETERANS SERVICE OFFICERS
MONTHLY REPORT AND CERTIFICATION OF PAY
County: Weld Month of: January , 2007
SECTION I: GENERAL INFORMATION SECTION II: NEW CLAIMS INITIATED
Telephone Calls 269 Appointed Representative:
Office (Walk-ins) 151 21-22 CVA 1
Home Visits 0 21-22 Other 9
Outreach Visits (i.e. NH...) 0
Community Events/Forums n Service Connected Disability Compensation
Correspondence Received 43 21-526 I(SC - New/) I 10
Correspondence Written 15 21-4138 - Other SC (Inc, Reopen, etc) g
Information and Referral/Inquiries 34
lontarts: VAMC Vanc [,5 Dependent Indemnity Compensation(DIC)
Requests for: 21-534 I 0
Military Records & Corrections
SF-180 10 Non-Service Connected Pension
DD 149/293 1 21-526 / 527
2
21-526/527 w/A&A 0
Request for Medical Treatment Records
21-4142 I I I 1 Death Pension /Widows Pension
21-534 1
Request for Medals 3 w/Accrued Benefits 0
Operation Recognition 0
Burial Allowance
Request for State Benefits: 1 21-530 I 2
Request for VTF Grant Assistance 0 Vocational Rehabilitation
28-1900 / CH 31 I 1
Request for VA Healthcare
10-10 EZ 5 Educational Assistance Programs
10-10 EZ-R 0 CH 30, 32, 34, 1607 0
CHAMPVA n CH 35 0
Miscellaneous Claims Claims for Disability Insurance
Other (Specify) Verif. of incone 13 29-357 / 29-4364 I 0
Other (Specify) 5655 1
Other (Specify) 21-8416 4 VA Home Loan
Other (Specify) VCAA Notice 1 26-1800/ 1817 I 2
21-4125 3
40-1330 1 Appeals
21-2008 1 NOD / DRO / VA9 I 1
CVA-26(Revised 2/1/2007)
U,q 000i
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 , 2007 from Weld County:
Paid In-Kind
Salary $ 3.887.46 Salary $
Expenses $ None Expenses $
Utilities County pays i lieu of rent Utilities $
Office Space $ None Office Space $
Telephone $ 95.96 Telephone $
Internet $ 82.99 Internet $
Office Supplies $ None Office Supplies $
Postage $ 23. 17 Postage $
Travel $ None Travel $
Training Conference $ None Training Conference $
Other Printer $ 96.00 Other $ _
Other $ None Other $
TOTAL $ 4, 185.58 +utilities TOTAL $
(Signature of County V raps Service Officer (Date)
Dorothy Strong, Veterans Counsc( r for
Pat Persichino, Veterans Service Officer
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In acc o7.,,,,_
ce with CRS 28-5-707, I hereby certify the accuracy of the Report(CVA-26, revised 2/1/2007):
" -1.'�' l2 t' 1- t.Lj-> `(-.
Dorothy Strong, Ve ans Counselor
v County Commissidrfer or Designee i
(Signature) eij7David E. Long, Chair CO ripiStit,
i ` r slg ,/�/,7li /1 `///_(Printod/Typed Name) `l' S/✓�'1 �
p '} ydEt.b CQL-tfN-v CLERK TO THE BOARD
Weld _ _ CCtranty`. y/ V
��
03/05/2007 Date SYLIEPi1TY CU:- .it THt BOAR?
ATTES1M :'.) b,,, ,. 0'r COU.v Y
C'JidF+lSSSIL'PlER S�GiiAi'JiiES 0IrLY
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)
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