HomeMy WebLinkAbout20174095.tiff•
COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY OF WELD MONTH OF OCTOBER 2017
SECTION I: GENERAL INFORMATION
Telephone Calls
534
Office (Public Contacts)
555
Home Visits
Outreach Visits (i.e. NH...)
Community Events/Forums
2
Request for Medals
4
Operation Recognition
Request for Medical Treatment Records
21-4142
23
Correspondence Received
95
Correspondence Written
90
Information and Referral/Inquiries
Other (i.e: VCAA Notice Response)
State Benefit(s)
13
Request for Military Records & Corrections
SF -180
19
DD 149
1
DD 293
NA 13075
Other ( )
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Ap ointed Representative:
21-22
CVA
63
21-22
Other
Claims for SC Entitlement:
21-526
(SC - New/)
65
21-4138
(SC - Informal Claim)
32
21-4138
(SC - New Issue)
41
21-4138
(SC - Reopen)
21-4138
(SC - Increase)
21-4138
(SC - secondary/Aggravation)
21-4138
(SC - Reinstatement)
21-4138
(SC w/ IU)
21-8940
(IU)
21-4192
(IU - Employer)
21-4138
(SMC)
21-686c
6
Non Service Connected Pension:
21-526
21-527
9
686c
21-526/527 w/ A&A
21-4138 (Reinstatement)
EVR (Any)
21-8416
5655
Request for Waivers/Compromise:
21-4138
5655 (FSR)
Dependent Indemnity Compensation (DIC)
21-534
4
w/ Accrued Benefits
/ _
Death Pension / Widows Pension
21-534
2
w/ Accrued Benefits
Request for VA Healthcare
10-10 EZ
16
10-10 EZ-R
3
10-583
10-10d (CHAMPVA - Dependents)
10-7959a (CHAMPVA)
10-7959C (CHAMPVA - Insurance Cert
Vocational Rehabilitation
28-1900 CH 31
3
28-1900 (Independent Living Program)
Educational Assistance Programs
MGIB
CH 30
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) 2017-4095
Other (Specify)
Other (Specify) VICIOod i
CVA-26 (Revised 8/2011)
�a/y
1 ' -/iA) /ca"41
SECTION II (Continued):
Burial Allowance
21-530
3
40-1330
1
21-2008
1
VA Home Loan
26-1880 (Certificate of Eligibility)
26-1817
3
Homeless Veterans Claims Filed
SC
NSC
Incarcerated Veterans
21-4193 Release/Reinstatement
21-4138 (Apportionment)
Appeals
NOD
1
VA 9
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
4
Hearing
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 October 2017
Salary
Expenses
Office Space
Telephone $240.27
Office Supplies
Travel
Training Conference
Other
Other
$9,000.00
Total $9,240.27
Weld County
lI - IS -1 7
(Signature of County Veterans Service Officer) (Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-707, I hereby certify the accuracy of the Report (CVA-26, revised 8/2011):
County Commissioner or Designee of
WELD — County
Date
DEC 0 4 2017
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 oZo/7, IA9 9.) -
Denver, CO 80222 CVA-26 (Revised 8/2011)
Hello