HomeMy WebLinkAbout20163121.tiffs
COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFIC��+ IO�¢�Y, rrr-
IV
COUNTY OF WELD MONTH OF AUGUST 2016
SECTION 1: GENERAL INFORMATION
Telephone
Calls
730
Office
(Public
Contacts)
I 608
Home
Visits
Outreach
Visits
(i.e.
NH...)
Community
Events/Forums
2
Request
for
Medals
Operation
Recognition JI8I
Request for Medical Treatment Records
21-4142
SEP 3 0 2016
WWtLL' COUNTY
.OMMISSI0NERa..
Correspondence
Received
80
Correspondence
Written
85
Information
and Referral/Inquiries
Other
(i.e: VCAA
Notice
Response)
State
Benefit(s)
12
Request
for Military
Records & Corrections
SF -180
5
DD
149
DD 293
NA
13075
Other
( )
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Appointed
Representative:
21-22
l 43
21-22
(CVA
Other
`
Claims
for SC Entitlement:
21-526
(SC -
New/)
_ 34
21-4138
(SC -
Informal
Claim)
23
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/ I
U)
21-8940
(IU)
21-4192
(IU
-
Employer)
21-4138
(SMC)
•
21-686c
Non Service Connected
Pension:
21-526
21-527
6
686c
21-526/527
w/ A&A
21-4138
(Reinstatement)
EVR
(Any)
21-8416
5655
Request for
Waivers/Compromise:
21-4138
I
5655 (FSR)
Dependent
Indemnity
Compensation
(DIC)
21-534
i 2
w/ Accrued
Benefits
Death
Pension / Widows Pension
21-534
I
2
w/ Accrued
Benefits
Request
for VA
Healthcare
10-10
EZ
11
10-10
EZ-R
10-583
10-10d
(CHAMPVA
-
Dependents)
10-7959a
(CHAMPVA)
10-7959C
(CHAMPVA
- Insurance
Cert
Vocational
Rehabilitation
28-1900
CH
31
I
28-1900
(Independent
Living Program)
Educational
Assistance
Programs
MGIB
CH
30
VEAP
CH
32
VN
Era GI
CH34
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)
Other
Specify)
Other
(Specify)
2016-312"
/ SECTION• II
C
r"„faze
vitt (Vfrie)
VAG too/
Burial
Allowance
21-530
2
40-1330
21-2008
VA
Home
Loan
26-1800
4
26-1817
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
wl VTF
(Grant), # Vets
Assisted
Rental
Assistance
Utilities
Assistance
Prescription
Assistance
/ Other
Medical
Food
Transportation
Clothing
Other
DRO Election
Review
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 of AUGUST 2016
Salary
Expenses
Office Space
Telephone
Office Supplies
Travel
Training Conference
Other
Other
$6,400.00
$277.67
Total $6,677.67
(Signature of County Veterans Service Officer) (Date)(C
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 9/1/2006): 2011)
seil\a;
Weld
OCT 0 5 2015
County Commissioner or Designee of
County
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
Denver, CO 80222
02D/L - •3/02
Hello