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Home My WebLink About20142219.tiff COLORADO DEPARTMENT OFM/LITARYAND VETERANS AFFAIRS COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY County of Weld JUNE SECTION I: GENERAL INFORMATION Telephone Calls 367 Correspondence Received 70 Office (Public Contacts) 381 Correspondence Written Home Visits Information and Referral/Inquiries 71 Outreach Visits (i.e. NH...) 2 Other(i.e: VCAA Notice Response) Community Events/Forums State Benefit(s) Request for Medals 5 Request for Military Records&Corrections Operation Recognition SF-180 15 DD 149 2 Request for Medical Treatment Records DD 293 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 30 21-534 4 21-22 Other w/Accrued Benefits Claims for SC Entitlement: Request for VA Healthcare 21-526 (SC - New/) 15 10-10 EZ 15 21-4138 (SC - Informal Claim) 10 10-10 EZ-R 1 21-4138 (SC - New Issue) 22 10-583 21-4138 (SC - Reopen) 5 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 21-4192 (IU - Employer) 28-1900 (Independent Living Program) 21-4138 (SMC) 21-686c 4 Educational Assistance Programs MGIB CH 30 Non Service Connected Pension: VEAP CH 32 21-526 VN Era GI CH 34 21-527 22-5490 CH 35 686c 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 Application Assistance Other(Specify) Dependent Indemnity Compensation (DIC) Other(Specify) 2014-2219 21-534 Other(Specify) wl Accrued Benefits CVA-26 (Revised 8/2011) Dr,' 740 S/are ©OO ca , )'4 7/ y V / SECTION II (Continued): Burial Allowance Claims for Insurance 21-530 29 -357 40-1330 29-4364 21-2008 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 NSC Transportation $500.00 Clothing Incarcerated Veterans Other _ 21-4193 Release/Reinstatement 21-4138 (Apportionment) Appeals DRO Election NOD 4 Review 5 VA 9 2 Hearing 2 SECTION III: CERTIFICATION BY COUNTY VETERANS SERVICE OFFICER I hereby certify, the above captioned monthly report is true and accurate. I have been paid the following amount(s)for the month c of October 2013 Weld County Salary _ .$ 4,894 Expenses Office Space Telephone _ $239.45 Office Supplies Travel Training Conference Other Other Total _ $5,133.45 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 1� accuracy of the Report(CVA-26, revised 8/2011): l¢>L —A41cc County Commissioner or Designee of Douglas(ademacher, Chair Wel d County JUL 2 3 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) ,40/4/- O141? Hello