HomeMy WebLinkAbout20150293.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS -MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY OF WELD MONTH OF DECEMBER 2014
SECTION I: GENERAL INFORMATION
Telephone Calls 368 Correspondence Received 81
Office (Public Contacts) 406 Correspondence Written 82
Home Visits Information and Referral/Inquiries
Outreach Visits(i.e. NH...) 2 Other(i.e: VCAA Notice Response)
Community Events/Forums 1 State Benefit(s) 4
Request for Medals Request for Military Records&Corrections
Operation Recognition SF-180 10
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 I Widows Pension
21-22 CVA 32 21-534
21-22 Other w/Accrued Benefits
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC- New/) 5 10-10 EZ
12
21-4138
(SC- Informal Claim) 1 10-10 EZ-R
21-4138 (SC- New Issue) 10 10-583
21-4138 (SC- Reopen) 10-10d
(CHAMPVA-Dependents)
21-4138 (SC-Increase) 15 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) 1 28-1900 (Independent Living Program) 1
21-4138 (SMC)
21-686c Educational Assistance Programs
MGIB CH 30
Non Service Connected Pension: VEAP CH 32
21-526 2 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 5 21-674
21-4138 (Reinstatement)
EVR (Any) Miscellaneous Claims
21-8416 2 21-8678 (Clothing Allowance) 1
5655 21-4502 (Auto Grant/Adaptive Equipment) 1
26-4555 (Housing Grant)
Request for Waivers/Compromise: 10-0103 (HISA Grant)
21-4138 Medicaid Application Assistance
5655 (FSR) SSA Application Assistance
Other(Specify)
Dependent Indemnity Compensation (DIC) Other(Specify)
21-534 2 Ot
her
w/Accrued Benefits 1 ,
(Specify)
/ J�� CVA-2i
2015-0293
1/2! G'c: Y ( J V ne-x7I
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
26-1880 (Certificate of Eligibility) 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 4 Review
VA 9 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 c of December 2014 Weld County
Salary Deo:Deon &Coc_ 4,894
Expenses
Office Space
Telephone _ $ 251.27
Office Supplies
Travel
Training Conference
Other
Other
Total _ $ 5,145.00
(Signature of County Veterans Service Officer) (Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-5-70�ereby certify the accuracy of the Report(CVA-26, revised 8/2011):
County Commissioner or Designee of
Barbara Kirkm yer, Cha r
Weld County
01/28/2015 Date
This certification, submitted monthly, properly signed and executed, will be considered as application for the
monetary benefits to the County General Fund, in accordance with 28-5-804 (2002) Colorado Revised Statue.
This form is to be submitted by the 15th day of the following month. Mail to:
Colorado Division of Veterans Affairs
Attention: Director Bill Conroy
1355 S. Colorado Blvd., Suite 113, Bldg C
Denver, CO 80222 CVA-26 (Revised 8/2011)
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