HomeMy WebLinkAbout20153088.tiff - -.
COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
- COUNTY VETERANS SERVICE OFFICERS -MONTHLY REPORT AND CERTIFICATION OF PAY
0 COUNTY OF WELD MONTH OF AUGUST 2015
SECTION I: GENERAL INFORMATION
Telephone Calls 380 Correspondence Received 81
Office(Public Contacts) 402 Correspondence Written 82
Home Visits Information and Referral/Inquiries 8
Outreach Visits (i.e. NH...) 1 Other(i.e: VCAA Notice Response) -
Community Events/Forums 2 State Benefit(s) 4
Request for Medals 1 Request for Military Records&Corrections
Operation Recognition SF-180 14
DD 149 1
Request for Medical Treatment Records DD 293 1
21-4142 I 2 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 2
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC-New/) 32 10-10 EZ 18
21-4138 (SC-Informal Claim) 8 10-10 EZ-R 2
21-4138 (SC- New Issue) 1 10-583
21-4138 (SC-Reopen) 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
21-8940 (IU) 28-1900 CH 31 1
21-4192 (IU-Employer) 28-1900(Independent Living Program)
21-4138 (SMC)
21-686c Educational Assistance Programs
MGIB CH 30 2
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) 2
Request for Waivers/Compromise: 10-0103 (HISA Grant)
21-4138 Medicaid Application Assistance
5655 (FSR) SSA Application Assistance
Other(Specify) 2015.3088
Dependent Indemnity Compensation (DIC) Other(Specify)
21-534 I Other(Specify) i 1
w/Accrued Benefits
CVA-26 (Revised 8/2011)
cc/ag v Dee /
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) 4 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 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 AUGUST 2015 County of Weld County
Salary Deon 4,200
Expenses
Office Space
Telephone $ 233.43
Office Supplies
Travel
Training Conference
Other
Other
Total $4,433.43
S 5
(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 8/2011):
County Commissioner or Designee of
County
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)
Hello