HomeMy WebLinkAbout20170249.tiffCOLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
•
County of Weld Month of December 2016
SECTION I: GENERAL INFORMATION
Telephone Calls
526
Office (Public Contacts)
590
Home Visits
Outreach Visits (i.e. NH...)
Community Events/Forums
2
Request for Medals
2
Operation Recognition
Request for Medical Treatment Records
21-4142
3
Correspondence Received
80
Correspondence Written
75
Information and Referral/Inquiries
Other (i.e: VCAA Notice Response)
State Benefit(s)
8
Request for Military Records & Corrections
SF -180
15
DD 149
2
DD 293
1
NA 13075
Other( )
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Appointed Representative:
21-22
CVA
22
21-22
Other
Claims for SC Entitlement:
21-526
(SC - New/)
26
21-4138
(SC - Informal Claim)
18
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 w/ IU)
21-8940
(IU)
2
21-4192
(IU - Employer)
2
21-4138
(SMC)
21-686c
Non Service Connected Pension:
21-526
21-527
4
686c
21-526/527 w/ A&A
5
21-4138 (Reinstatement)
EVR (Any)
21-8416
5655
Request for Waivers/Compromise:
21-4138
5655 (FSR)
Dependent Indemnity Compensation
(DIC)J
6
1-534
F/
Accrued Benefits
Death Pension / Widows Pension
21-534
w/ Accrued Benefits
2
Request for VA Healthcare
10-10 EZ
1
10-10 EZ-R
10-583
10-10d (CHAMPVA - Dependents)
1
10-7959a (CHAMPVA)
10-7959C (CHAMPVA - Insurance Cert
1
Vocational Rehabilitation
28-1900 CH 31
1
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) 2017-0249
Other (Specify)
Other (Specify)
CVA-26 (Revised 8/2011)
e -
I —,7241—l7
V'cx, OOO I
SECTION II (Continued):
Burial Allowance
21-530
1
21-2008
:21j
VA Home Loan
26-1880 (Certificate of Eligibility)
26-1817
2
Homeless Veterans Claims Filed
SC
NSC
Incarcerated Veterans
21-4193 Release/Reinstatement
21-4138 (Apportionment)
Appeals
NOD
VA 9
2
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
2
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 2016 Weld County
Salary Deo n & Wendy $6,000.00
Expenses
Office Space
Telephone $250.22
Office Supplies
Travel
Training Conference
Other
Other
Total $6,250.22
/ /S 17
(Signature of County Veterans Service Officer) (Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 2 -5-707, I hereby certify the accuracy of the Report (CVA-26, revised 8/2011):
County Commissioner or Designee of
e A. Cozad, Cha
Weld County
JAN 2 3 2017
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 355 S. Col doBlvd., Suite 113, Bldg C 02-0/7' 41-7
Denver, CO 80222 CVA-26 (Revised 8/2011)
Hello