HomeMy WebLinkAbout20141829.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
0 - COUNTY OF WELD APRIL 2014
SECTION I: GENERAL INFORMATION
Telephone Calls 293 Correspondence Received
Office(Public Contacts) 378 Correspondence Written 75
Home Visits Information and Referral/Inquiries 70
Outreach Visits (i.e. NH...) Other(i.e: VCAA Notice Response)
Community Events/Forums 2 State Benefit(s)
1
(Request for Medals i J Request for Military Records&Corrections
Operation Recognition I SF-180
DD 149 45
Request for Medical Treatment Records DD 293 2
21-4142 II NA 13075 3
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 I 37 21-534
21-22 Other w/Accrued Benefits I 21
1
Claims for SC Entitlement:
21-526 (SC-New/) 10 10-10 EZ Request for VA Healthcare
21-4138 (SC -Informal Claim) 1 10-10 EZ-R 29
21-4138 (SC -New Issue) 15 10-583
21-4138 21-4138 (SC -Reopen) 10-10d (CHAMPVA- Dependents) 1
21-4138 (SC -Increase) 10 10-7959a (CHAMPVA)
(SC -s.c«w,rywn,0,.,ap„) 10-7959C (CHAMPVA- Insurance Cert
(SC - Reinstatement) 1
21-4138
21-4138 (SC wl IU) Vocational Rehabilitation 21-8940 (IU) 128-1900
21-4192 (IU - Employer) 1 CH r
21-4138 (SMC) 28-1900 (Independent Living Program)
21-686c Educational Assistance Programs
MGIB CH 30
Non Service Connected Pension: VEAP CH 32
21-526 4 VN Era GI
21-527 CH 34
3 22-5490 CH 35
686c 1 Sel Reservist NG CH 1607
21-526/527 w/A&A 5 21-674
21-4138(Reinstatement)
EVR (Any)
21.8416 Miscellaneous Claims
5655 21-8678 (Clothing Allowance)
21-4502 (Auto Grant/Adaptive Equipment)
26-4555 (Housing Grant)
Request for Waivers/Compromise: 10-0103
21-4138 I I (HISA Grant)
5655 (FSR) Medicaid Application Assistance
SSA Application Assistance
Dependent Indemnity Compensation (DIC
)) Other(Specify)
I21-534 Other(Specify)
I 2 Other(Specify)
w/Accrued Benefits 1
41rCVA-26 ( 2014-1829
(D/)oy v ee:kA(d4) 4%* V4 cue) 1
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) I Requests w/VTF (Grant),#Vets Assisted
26-1817 Rental Assistance
Utilities Assistance
Homeless Veterans Claims Filed
Prescription Assistance/Other Medical
Food $ 500.00
NSC Transportation $500.00
Clothing
Incarcerated Veterans Other
21-4193 Release/Reinstatement I
21-4138(Apportionment)
Appeals DRO Election
IReview
VA 9 VO9 l 3I 'Hearing I I
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 (of April 2014 Weld County
Salary Dee'n &Cody _ 4,894
Expenses
Office Space
Telephone _ $ 259.40
Office Supplies
Travel
Training Conference
Other
Other
Total _ $ 5,153.40
(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):
(Pc County Commissioner or Designee of
Weld
County
JUN 18 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 foram 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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