HomeMy WebLinkAbout20151481.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY OF WELD MONTH OF APRIL 2015
SECTION I: GENERAL INFORMATION
Telephone Calls 325 Correspondence Received 64
Office (Public Contacts) 395 Correspondence Written 60
Home Visits 1 Information and Referral/Inquiries
Outreach Visits (i.e. NH...) 1 Other(i.e: VCAA Notice Response)
Community Events/Forums 1 State Benefit(s)
Request for Medals Request for Military Records &Corrections
Operation Recognition SF-180 18
DD 149
Request for Medical Treatment Records DD 293
21-4142 I 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 38 21-534 2
21-22 Other w/Accrued Benefits 1
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC - New/) 15 10-10 EZ 14
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) 1
21-4138 (SC - Increase) 10-7959a (CHAMPVA)
21-4138 (SC -Secondary/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 1
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
cibAtate> 2015-1481
5 -077-02o/5- cc 11) YA 000 I
5-027- /g
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 1 29-4364
21-2008 1 29-336 (Designation of Beneficiary)
21-4125 (Claim for Lump Sum Payment)
VA Home Loan
26-1800 Requests w/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 4 Review 2
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-15 COUNTY OF WELD
Salary $5,246.00
Expenses
Office Space
Telephone 242.76
Office Supplies
Travel
Training Conference
Other
Other
Total 5,488.76
(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 9/1/200(2011)
County Commissioner or Designee of
Mike Freeman, Pro—Tern
Weld County
MAY 2 7 2015 Date
0,74 - /qv
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