HomeMy WebLinkAbout20161704.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS -MONTHLY REPORT AND CERTIFICATIOpI,QE p. .IV
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COUNTY OF WELD MONTH OF APRIL 2016 P Y t t
MAY 242D13
SECTION 1: GENERAL INFORMATION WELD COUNTY
COMMISSIONERS
Telephone Calls 454 Correspondence Received 85
Office(Public Contacts) - 459 Correspondence Written 80
Home Visits Information and Referral/Inquiries
Outreach Visits (i.e. NH...) 1 Other(i.e: VCAA Notice Response)
Community Events/Forums 2 State Benefit(s) 2
Request for Medals 4 Request for Military Records&Corrections
Operation Recognition SF-180 18
DD 149 1
Request for Medical Treatment Records DD 293 2
21-4142 I 4, NA 13075
Other( )
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Appointed Representative: Death Pension/Widows Pension
21-22 CVA • 42 . .21-534 2
21-22 Other wl Accrued Benefits 1
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC-New!) 20 10-10 EZ 15
21-4138 (SC-Informal Claim) 3 10-10 EZ-R
21-4138 (SC-New Issue) 22 10-583
21-4138 (SC-Reopen) 12 10-10d (CHAMPVA-Dependents) 1
21-4138 (SC-Increase) 10-7959a (CHAMPVA)
21-4138 (SC-Sewndary/Aggrevagon) 10-7959C (CHAMPVA-Insurance Cert
21-4138 (SC- Reinstatement)
21-4138 (SC WI IU) Vocational Rehabilitation
21-8940 (IU) 28-1900 CH 31
21-4192 (IU-Employer) 28-1900(Independent Living Program)
21-4138 (SMC)
21-686c _ Educational Assistance Programs
MGIB CH 30 8
Non Service Connected Pension: VEAP CH 32
21-526 VN Era GI CH 34
21-527 8 22-5490 CH 35
686c 2 Sel Reservist NG CH 1607
21-526/527 wl AM 21-674
21-4138 (Reinstatement)
EVR (Any) Miscellaneous Claims
21-8416 21-8678 (Clothing Allowance)
5655 21-4502 (Auto Grant/Adaptive Equipment)
26-4555 (Housing Grant)
Request for Waivers/Compromise: 10-0103 (HISA Grant)
21-4138 2 Medicaid Application Assistance 2016-1704
5655 (FSR) SSA Application Assistance
Other(Specify)
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Dependent Indemnity Compensation (DIC) Other(Specify)
21-534 Other(Specify)
w/Accrued Benefits
SECTION II (Continued):
Burial Allowance Claims for Insurance
21-530 1 29 -357
40-1330 1 29-4364
21-2008 1 29-336 (Designation of Beneficiary)
21-4125 (Claim for Lump Sum Payment)
VA Home Loan
26-1800 5 Requests WI VTF (Grant), #Vets Assisted
26-1817 Rental Assistance
Utilities Assistance
Homeless Veterans Claims Filed Prescription Assistance/Other Medical
SC Food
NSC Transportation
Clothing
Incarcerated Veterans Other
21-4193 Release/Reinstatement
21-4138 (Apportionment)
Appeals DRO Election
NOD 1 Review 1
VA 9 2 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 Apr-16 COUNTY OF WELD
Salary _ $6,200.00
Expenses
Office Space
Telephone 267.56
Office Supplies
Travel
Training Conference
Other
Other
Total _ 6,467.50
(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 9/1/2(2011)
U l tt-1 g'l.es County Commissioner or Designee of
weld County
JUN 0 1 201E Date
This certification, submitted monthly, properly signed and executed, will be considered as application for the
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