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Home My WebLink About20140265.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY COUNTY OF: WELD DECEMBER 2013 SECTION I : GENERAL INFORMATION Telephone Calls 541 Correspondence Received 195 Office (Public Contacts) 220 Correspondence Written 71 Home Visits Information and Referral/Inquiries Outreach Visits (i.e. NH. . . ) 3 Other (i.e: VCAA Notice Response) 12 Community Events/Forums State Benefit(s) 4 Request for Medals 2 Request for Military Records & Corrections Operation Recognition SF-180 DD 149 2 Request for Medical Treatment Records DD 293 214142 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 25 21 -534 3 21-22 Other w/ Accrued Benefits Claims for SC Entitlement: Request for VA Healthcare 21 -526 (SC - New/) 10 10-10 EZ 21 -4138 (SC - Informal Claim) 10-10 EZ-R 21 -4138 (SC - New Issue) . 10-583 21 -4138 (SC - Reopen) 5 10-10d (CHAMPVA - Dependents) 21 -4138 (SC.- Increase) 10 10-7959a (CHAMPVA) 3 21 -4138 (SC - SewroeMAUWavauon) 10-7959C (CHAMPVA - Insurance Cert 21 -4138 (SC - Reinstatement) 21 -4138 (SC wl IU) Vocational Rehabilitation 21 -8940 (IU) 28-1900 CH 31 21 -4192 (IU - Employer) 28-1900 (Independent Living Program) 21 -4138 (SMC) 21 -686c Educational Assistance Programs MGIB CH 30 1 Non Service Connected Pension: VEAP CH 32 21 -526 5 VN Era GI CH 34 21 -527 5 22-5490 CH 35 686c 5 Sel Reservist NG CH 1607 21 -526/527 w/ A&A 5 21 -674 21 -4138 (Reinstatement) EVR (Any) Miscellaneous Claims 21 -8416 21 -8678 (Clothing Allowance) 1 5655 21 -4502 (Auto Grant / Adaptive Equipment) 2 26-4555 (Housing Grant) Request for Waivers/Compromise: 10-0103 (HISA Grant) 214138 Medicaid Application Assistance 5655 (FSR) • SSA Application Assistance Other (Specify) Dependent Indemnity Compensation (DIC) Other (Specify) 21-534 2 Other (Specify) w/ Accrued Benefits 2014-0265 orrg - t-5talc Pr 11/ A 1 - 21- 11-1 Vfc © dot 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 3 Food 1 ,000 NSC Transportation 800 Clothing Incarcerated Veterans Other 21 -4193 Release/Reinstatement 3 21 -4138 (Apportionment) Appeals DRO Election NOD 10 Review 5 VA 9 3 Hearing 3 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 ( DECEMBER 2013 WELD Salary 4,887.53 Expenses Office Space Telephone 263.73 Office Supplies Travel Training Conference Other Other Total 5, 151 .26 (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 /20( 2011 ) r eu, lti0 d4 rr, c {w County Commissioner or Designee of ouj1as Rademacher , Chair Weld County , Colorado County 01 / 29 / 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 9/1/2006) Hello