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COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS RECEIVED
COUNTY VETERANS SERVICE OFFICERS-MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of WELD Month of July_2015 MV 18
2015 WELQCOUNTY
SECTION I. GENERAL INFORMATION
Comum1ONERS
Telephone Calls 345 Correspondence Received 80
Office(Public Contacts) 414 Correspondence Written 70
Home Visits 0 Information and Referral/Inquiries
Outreach Visits(i.e. NH...) 3 Other(Le: VCAA Notice Response)
Community Events/Forums 1 State Benefit(s) 5
Request for Medals 2 Request for Military Records&Corrections
Operation Recognition 0 SF-180 10
DD 149 1
Request for Medical Treatment Records DD 293 0
21-4142 I 0 NA 13075 0
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: 40 21-534 5
21-22 Other 0 w/Accrued Benefits 1
Claims:for SC Entitlement Request for VA Healthcare
21-526. ... (SC New/) 40 10-10 EZ 14
21-4138 (SC-Informal Claim) 8 10-10 EZ-R 2
21-4138 (SC New,Issue) 5 10-583 0
21-4138 (SC-Reopen) 2 10-10d (CHAMPVA Dependents) . 0
21-4138. . (SC-Increase) 2 10-7959a (CHAMPVA) 0
21-4138 (SC-s.oab.ylAsprevuon) 0 10-7959C (CHAMPVA-insurance Cert 0
21-4138... (SC.-.Reinstatement) 2
21-4138. (SC w/IU) 2 Vocational Rehabilitation
21-8940. •(IU). 2 28-1900 CH 31 0
21-4192 (IU-Employer) 0 28-1900(Independent Living Program) 0
21-4138 (SMC) 0
21-686c 5 Educational Assistance Programs
MGIB CH 30 0
Non Service Connected Pension: VEAP CH 32 0
21-526 0 VN Era GI CH 34 0
21-527 .0 22-5490 CH•35 • 0
686c 0 Sel Reservist NG CH 1607 0
21-526/527 w/ABTA 4 21-674 0
21-4138(Reinstatement) 0
EVR(Any) 0 Miscellaneous Claims
21-8416 0 21-8678 (Clothing Allowance) 0
5655 0 21-4502 (Auto Grant/Adaptive Equipment) 0
26-4555 (Housing Grant) 0
Request for Waivers/Compromise: 10-0103 QHISA Grant) . 0
21-4138 0 Medicaid Application Assistance 0
5655(FSR) 0 SSA Application Assistance 0
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Other(Specify) 0
Dependent Indemnity Compensation (DIC) Other(Specify) 0
21-534 0 Other(Specify) 0
w/Accrued Benefits 0
SECTION II (Continued):
Burial Allowance Claims for Insurance
21-530 3 29-357 0
40-1330 1 29-4364 0
21-2008 0 29-336(Designation of Beneficiary) 0
21-4125 (Claim for Lump Sum Payment) 0
VA Home Loan
26-1800 7 Requests w/VTF(Grant),#Vets Assisted
26-1817 0 Rental Assistance 0
Utilities Assistance 0
Homeless Veterans Claims Filed Prescription Assistance/Other Medical 0
SC 2 Food 0
NSC 0 Transportation 0
Clothing 0
Incarcerated Veterans Other 0
21-4193 Release/Reinstatement 0
21-4138 (Apportionment) 0
Appeals DRO Election
NOD 1 Review 0
VA 9 1 Hearing 0
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 July 2015 from_Weld County
Salary 4,200
Expenses
Office Space
Telephone $241
Office Supplies
Travel
Training Conference
Other
Other
Total 4,441.00
- - s
(Signature of County Veterans Service Officer) (Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
Ih itcordance with CRS 28-5-707, I ereby certify the accuracy of the Report(CVA-26, revised 9/1/20012011)
A- County Commissioner or Designee of
arbara Kirkme er, Ch r
Weld County
AUG 2 4 2015 Date
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