HomeMy WebLinkAbout20141340.tiff • 11. COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS -MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY OF WELD MONTH OF MARCH 2014
SECTION I: GENERAL INFORMATION
Telephone Calls 469 Correspondence Received 70
Office(Public Contacts) 375 Correspondence Written 21
Home Visits Information and Referral/Inquiries
Outreach Visits (i.e. NH...) 1 Other(i.e: VCAA Notice Response)
Community Events/Forums 1 State Benefit(s) 8
Request for Medals 3 Request for Military Records&Corrections
Operation Recognition SF-180 26
DD 149 2
Request for Medical Treatment Records DD 293
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 I Widows Pension
21-22 CVA 40 21-534 1
21-22 Other w/Accrued Benefits 1
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC - New/) 15 10-10 EZ 21
21-4138 (SC -Informal Claim) 3 10-10 EZ-R 1
21-4138 (SC -New Issue) 10 10-583
21-4138 (SC- Reopen) 2 10-10d (CHAMPVA- Dependents) 3
21-4138 (SC - Increase) 8 10-7959a (CHAMPVA)
214138 (SC -seconda IAggravatwn) 10-7959C (CHAMPVA- Insurance Cert
21-4138 (SC -Reinstatement)
21-4138 (SC w/IU) Vocational Rehabilitation
21-8940 (IU) 28-1900 CH 31 1
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 3 VN Era GI CH 34
21-527 3 22-5490 CH 35
686c 2 Sel Reservist NG CH 1607
21-526/527 w/A&A 4 21-674
21-4138 (Reinstatement)
EVR (Any) Miscellaneous Claims
21-8416 21-8678 (Clothing Allowance)
5655 21-4502 (Auto Grant/Adaptive Equipment) 1
26-4555 (Housing Grant) 1
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) 2014-1340
21-534 1 Other(Specify)
w/Accrued Benefits 1
6SfxTe. y.Sp-/9 CVA-26 (Revised 8/2011)
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- SECTION II (Continued):
Burial Allowance Claims for Insurance
21-530 2 29-357
40-1330 2 29-4364
21-2008 2 29-336 (Designation of Beneficiary)
21-4125 (Claim for Lump Sum Payment)
VA Home Loan
26-1880 (Certificate of Eligibility) 2 Requests WI VTF (Grant),#Vets Assisted
26-1817 Rental Assistance
Utilities Assistance
Homeless Veterans Claims Filed Prescription Assistance/Other Medical
SC Food
NSC Transportation
Clothing
Incarcerated Veterans Other
21-4193 Release/Reinstatement
21-4138 (Apportionment)
Appeals DRO Election
NOD 5 Review 1
VA 9 1 Hearing 1
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 (MARCH 2014 Weld County
Salary 4,894
Expenses
Office Space
Telephone 257.41
Office Supplies •
Travel
Training Conference
Other
Other
Total 5,151
k>21(7/ I 5 ---
(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):
r�C sack tJ County Commissioner or Designee of
Doug as Radem cher, Chair
WELD County
APR 3 9 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)
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