HomeMy WebLinkAbout20151314.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY OF WELD MONTH OF MARCH 2015
SECTION I : GENERAL INFORMATION
Telephone Calls 322 Correspondence Received 65
Office (Public Contacts) 404 Correspondence Written
Home Visits Information and Referral/Inquiries 60
Outreach Visits (i.e. NH . . . ) 3 Other (i.e: VCAA Notice Response)
Community Events/Forums State Benefit(s)
Request for Medals Request for Military Records & Corrections
Operation Recognition _ SF-180 8
DD 149
Request for Medical Treatment Records DD 293
21 -4142 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 40 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)
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
i 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
i 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 Applica ion Assistance
5/1 02065 1314
� � ✓ /
1/12t000 I
Cc I VA ( DtF�
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 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 Mar- 15 COUNTY OF WELD
Salary $5,246. 00
Expenses
Office Space
Telephone 244.64
Office Supplies
Travel
Training Conference
Other
Other
Total 5,490.64
,(-Kj jig
(Signature of County Veterans Service Officer) (Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-707, I h reby certify the accuracy of the Report (CVA-26, revised 9/1 /200( 2011 )
j/>_„) County Commissioner or Designee of
Barbara Kirkmneyer , Chair , Commissione£lounty
5 / 11 / 2015 Date
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