HomeMy WebLinkAbout20140565.tiff •
COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS -MONTHLY REPORT AND CERTIFICATION OF PAY
County of Weld Month of January 2014
SECTION I: GENERAL INFORMATION
Telephone Calls 642 Correspondence Received 75
Office (Public Contacts) 220 Correspondence Written 70
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) 1
Request for Medals 1 Request for Military Records&Corrections
Operation Recognition SF-180 18
1
DD 149 4
Request for Medical Treatment Records DD 293
21-4142 1 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 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
i 21-4138 (SC - New issue) 10 10-583
21-4138 (SC - Reopen) 10-10d (CHAMPVA- Dependents) 1
21-4138 (SC - Increase) 15 10-7959a (CHAMPVA)
21-4138 (SC -seconday/Aggravation) 10-7959C (CHAMPVA- Insurance Cert 1
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)
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 Other(Specify)
w/4ccrued Benefits 1
- CVA 2014-0555
Dr:q A0 sia
• 6 'LI c?e,.* 14A -3/3 ✓i4 coo/
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 w/VTF (Grant),#Vets Assisted
26-1817 Rental Assistance
Utilities Assistance
Homeless Veterans Claims Filed Prescription Assistance/Other Medical
SC Food
$700.00
NSC
Transportation $150.00
Clothing
Incarcerated Veterans Other
21-4193 Release/Reinstatement
21-4138 (Apportionment)
Appeals DRO Election
NOD 4 Review 5
VA 9 10 Hearing 2
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 i of January 2014 Weld County
Salary 4,894
Expenses
Office Space
Telephone _ $ 306.42
Office Supplies
Travel
Training Conference
Other
Other
Total $ 5,200.42
/09 / - /_S - III
(Signature of County Veterans Service Officer) (Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance va�'tth CRS28-5-707, I hereby ycertify the accuracy of the Report (CVA-26, revised 8/2011):
XJ TLS ko tair-I & J County Commissioner or Designee of
Douglas Rade acher
WET,T) County
FEB 2 6 2014 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)
0747/4= e 45
Hello