HomeMy WebLinkAbout20142974.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS-MONTHLY REPORT AND CERTIFICp�[GItF .�TE D
County of Weld Month of August 2014 f'1 C(� V
SEP 2 2 2014
SECTION I:GENERAL INFORMATION WELD COUNTY
COMMISSIONERS
Telephone Calls 422 Correspondence Received 65
Office(Public Contacts) 406 Correspondence Written
Home Visits Information and Referral/Inquiries 60
Outreach Visits(i.e.NH...) 1 Other(i.e:VCAA Notice Response)
Community Events/Forums State Benefit(s)
Request for Medals 2 Request for Military Records&Corrections
Operation Recognition SF-180 8
DD 149 1
Request for Medical Treatment Records DD 293 1
21-4142 I 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 I 40 21-534 2
21-22 Other J w/Accrued Benefits 1
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC-New/) 15 10-10 EZ 10
21-4138 (SC-Informal Claim) 3 10-10 EZ-R 2
21-4138 (SC-New Issue) 22 10-583
21-4138 (SC-Reopen) 10 10-10d (CHAMPVA-Dependents)
21-4138 (SC-Increase) 10-7959a (CHAMPVA)
21-4138 (SC-Secontlanvggravalion) 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 2 Educational Assistance Programs
MGIB CH 30 1
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) 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) 2014-2974
21-534 Other(Specify)
w/Accrued Benefits
CVA-26(Revised 8/2011)
cc,V, (bH)
q'-29-/4 l brl9 Cost-a Viq ;'
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 2 Requests wl VTF(Grant),#Vets Assisted
26-1817 Rental Assistance
Utilities Assistance
Homeless Veterans Claims Filed Prescription Assistance/Other Medical
SC I Food
NSC 1 Transportation
Clothing
Incarcerated Veterans Other
21-4193 Release/Reinstatement
21-4138(Apportionment)
Appeals DRO Election
NOD e
VA 9 421
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 2014 County of Weld County
Salary 4,894
Expenses
Office Space
Telephone $243.62
Office Supplies
Travel
Training Conference
Other
Other
Total _$5,140.62
1F,,61"( /S. /1/
(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):
her iL C� County Commissioner or Designee of
Weld
County
SEP 2 9 20)4 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 loam 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)
ao/ ,?974
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