HomeMy WebLinkAbout20150794.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PI
COUNTY OF WELD MONTH OF FEBRUARY 2015
SECTION I: GENERAL INFORMATION
Telephone Calls 322 Correspondence Received
Office (Public Contacts) 424 Correspondence Written
Home Visits Information and Referral/Inquiries
Outreach Visits (i.e, NH...) 1 Other (i.e: VCAA Notice Response)
Community Events/Forums State Benefit(s)
Request for Medals 4 Request for Military Records &Correctic
Operation Recognition SF-180
DD 149
Request for Medical Treatment Records DD 293
21-4142 I NA 13075
Other (
SECTON It: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Appointed Representative: Death Pension /Widows Pension
21-22 CVA 40 21-534
21-22 Other w/Accrued Benefits
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC - New/) 15 10-10 EZ
21-4138 (SC - Informal Claim) 3 10-10 EZ-R
21-4138 (SC • New Issue) 22 10-583
21-4138 (SC - Reopen) 10 10-10d (CHAMPVA - Dependents)
21-4138 (SC - Increase) 10-7959a (CHAMPVA)
21-4138 (SC -Seco<cary/Aggravation) 10-7959C (CHAMPVA- Insurance Cert
21-4138 (SC - Reinstatement)
21-4138 (SC w/ IU) Vocational Rehabilitation
21-8940 (IU) 28-1900 CH 31
21-4192 (IU - Employer) 28-1900 (Independent Living Program)
21-4138 (SMC)
21-686c 2 Educational Assistance Programs
MGIB CH 30
Non Service Connected Pension: VEAP CH 32
21-526 VN Era GI CH 34
21-527 2 22-5490 CH 35
686c 2 Sel Reservist NG CH 1607
21-526/527 w/A&A 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 Medicaid Application Assistance
5655 (FSR) SSA Application Assistance
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5-026—c2O/5 Y'/40)4) VFI6OO )
Other(Specify)
Dependent Indemnity Compensation (DIC) Other(Specify)
21-534 2 Other(Specify)
w/Accrued Benefits
SECTION II (Continued):
Burial Allowance Claims for Insurance
21-530 2 29 -357
40-1330 29-4364
21-2008 29-336 (Designation of Beneficiary)
21-4125 (Claim for Lump Sum Payment)
VA Home Loan
26-1800 Requests w/VTF (Grant), #Vets Ass':
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 4 Review
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 Feb-15 COUNTY OF WELD
Salary $4,894.00
Expenses
Office Space
Telephone 244.64
Office Supplies
Travel
Training Conference
Other
Other
Total 4,918.64
(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 9/1/2001
/7
. c `A L County Commissioner or Designee i
arbara Kirkme er, Chai
Weld County
MAR 2 5 2015 Date
(.9o/5-07951
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