HomeMy WebLinkAbout20163702.tiffCOLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
County of Weld Month of October 2016
SECTION I: GENERAL INFORMATION
Telephone Calls
539
Office (Public Contacts)
651
Home Visits
Outreach Visits (i.e. NH...)
Community Events/Forums
2
Request for Medals
Operation Recognition
Request for Medical Treatment Records
21-4142
2
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
9
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
41
21-22
Other
Claims for SC Entitlement:
21-526
(SC - New/)
32
21-4138
(SC - Informal Claim)
16
21-4138
(SC - New Issue)
20
21-4138
(SC - Reopen)
21-4138
(SC - Increase)
214138
(SC - secordaryrnoyrevNlon)
21-4138
(SC - Reinstatement)
21-4138
(SC w/ IU)
21-8940
(IU)
21-4192
(IU - Employer)
21-4138
(SMC)
21-686c
Non Service Connected Pension:
21-526
21-527
4
686c
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
6
w/ Accrued Benefits
Death Pension / Widows Pension
21-534
w/ Accrued Benefits
2
Request for VA Healthcare
10-10 EZ
7
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
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Other (Specify)
Other (Specify) 2016-3702
Other (Specify) /A
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CVA-26 (Revised 8/2011)
SECTION II (Continued):
Burial Allowance
21-530
2
40-1330
1
21-2008
1
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 October 2016 Weld County
Salary Deo' n & Wendy $6,000.00
Expenses
Office Space
Telephone $258.30
Office Supplies
Travel
Training Conference
Other
Other
Total _ $6,258.30
(Signature of County Veterans Service Officer)
7/-Is'IC
(Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-7
I Fpereby certify the accuracy of the Report (CVA-26, revised 8/2011):
+zi County Commissioner or Designee of
A. Cozad, C air Pro-Tem
Weld
County
DEC 0 7 2016 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 CVA-26 (Revised 8/2011)
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