HomeMy WebLinkAbout20170670.tiffCOLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY OF WELD MONTH OF JANUARY 2017
SECTION I: GENERAL INFORMATION
Telephone
Calls
660
Office
(Public Contacts)
476
Home Visits
Outreach Visits (i.e. NH...)
Community Events/Forums
Request
for Medals
2
Operation
Recognition
Request for Medical Treatment Records
21-4142
Correspondence
Received
75
Correspondence
Written
70
Information
and Referral/Inquiries
Other (i.e: VCAA Notice Response)
,
'State Benefits)
5
Request for Military Records & Corrections
SF -180
16
DD 149
4
DD 293
NA 13075
Other
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Appointed
Representative:
21-22
CVA 43
21-22
Other
Claims for SC Entitlement:
21-526
(SC - New/)
40
21-4138
(SC - Informal
28
Claim)
21-4138
(SC - New Issue; ,
21-4138
(SC - Reopen:
-21-4138
(SC - Increase)
21-4138
(SC - Secondary/Aggravation)
21-4138
(SC - Reinstatement)
21-4138
(SC wl IU)
21-8940
(IU)
21-4192
(IU - Employer)
2
21-4138
(SMC)
21-686c
1
Non Service Connected Pension:
21-526
21-527
9
686c
5
21-526/527 wl AM
5
21-4138 (Reinstatement:
EVR (Any)
21-8416
5655
Request for Waivers/Compromise:
21-4138
5655 (FSR)
Dependent Indemnity Compensation
(DIC)
21-534 1
w/ Accrued Benefits
Death Pension / Widows Pension
21-534
w/ Accrued Benefits
4
1
Request
for VA Healthcare
10-10 EZ
12
10-10 EZ-R
3
10-583
10-10d (CHAMPVA - Dependents)
10-7959a (CHAMPVA)
10-7959C (CHAMPVA - Insurance Cert _
1
Vocational Rehabilitation
28-1900 CH 31
28-1900 (Independent
Living Program)
Educational Assistance Programs
MGIB CH 30
1
VEAP CH 32 ,
VN Era GI CH 34
22-5490 CH 35
Sel Reservist NG CH 1607
21-674
Miscellaneous Claims
21-8678 (Clothing Allowance)
21-4502 (Auto Grant / Adaptive
Equipment)
26-4555 (Housing Grant)
10-0103 (HISA Grant)
Medicaid Application
Assistance
SSA Application
Assistance
Other (Specify)
2017-0670 .
Other (Specify)
,
Other (Specify)
i
CVA-26 (Revised 8/2011)
/u)e3 Ncp//7
SECTION II (Continued):
Burial Allowance
21-530
8
40-1330
2
21-2008
1
VA Home Loan
26-1880 (Certificate of Eligibility)
10
26-1817
Homeless Veterans Claims Filed
SC
NSC
Incarcerated Veterans
21-4193 Release/Reinstatement
21-4138 (Apportionment)
AQneals
NOD
2
VA 9
3
Claims for Insurance
29 -357
29-4364
29-336 (Designation of Beneficiary)
21-4125 (Claim for Lump Sum Payment)
Requests w/ VTF (Grant), # Vets Assisted
Rental Assistance
Utilities Assistance
Prescription Assistance / Other Medical
Food
Transportation
Clothing
Other
DRO Election
Review
Hearing
4
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 c of January 2017 Weld County
Salary Deo n&Wendy $7,000.00
Expenses
Office Space
Telephone $278.23
Office Supplies
Travel
Training Conference
Other
Other
Total $ 7,278.23
(Signature of County Veterans Service Officer) (Date
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-707, I
C:7241.11;
Julie A. Cozad, C1ir
eby certify the accuracy of the Report (CVA-26, revised 8/2011):
County Commissioner or Designee of
Weld County
MAR 0620
7 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: Director Bill Conroy
1355 S. Colorado Blvd., Suite 113, Bldg C o2 O/7— 0 70
Denver, CO 80222 CVA-26 (Revised 8/2011)
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