HomeMy WebLinkAbout20141010.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
0 COUNTY VETERANS SERVICE OFFICERS-MONTHLY REPORT AND CERTIFICATION OF PAY
County Of Weld Month Of February 2014
SECTION I: GENERAL INFORMATION
Telephone Calls 509 Correspondence Received 75
Office(Public Contacts) 306 Correspondence Written 70
Home Visits Information and Referral/Inquiries
Outreach Visits(i.e. NH...) Other(i.e: VCAA Notice Response)
Community Events/Forums 1 State Benefit(s) 1
Request for Medals Request for Military Records&Corrections
Operation Recognition SF-180 30
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 1 Widows Pension .
21-22 CVA 37 21-534 4
21-22 Other w/Accrued Benefits 1
•
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC- New/) 10 10-10 EZ 24
21-4138 (SC-Informal Claim) 1 10-10 EZ-R
21-4138 (SC-New Issue) 15 10-583
21-4138 (SC-Reopen) 10-10d (CHAMPVA- Dependents)
21-4138 (SC-Increase) 10 10-7959a (CHAMPVA)
'21-4138 (SC-Secondary/Aggravation) 10-7959C (CHAMPVA- Insurance Cert 1.
21-4138 (SC-Reinstatement)
21-4138 (SC w/IU) Vocational Rehabilitation
21-8940 (IU) 28-1900 CH 31
21-4192 (IU - Employer) 1 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 4 VN Era GI CH 34
21-527 3 22-5490 CH 35
686c 0 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) 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)
21-534 2 Other(Specify)
w/Accrued Benefits 1
�S71 CVA-26 2014-1010
I ' I CG'.' A le- 8-1 1//t /
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) Requests wl 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 10 Review 5
VA 9 3 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 :of February 2014 Weld County
Salary Deoi n &Cody _ 4,894
Expenses
Office Space
Telephone _ $ 259.40
Office Supplies
Travel
Training Conference
Other
Other
Total
$ 5,153.40
(1n
(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):
5'Lc, CO y4-ickFihe r County Commissioner or Designee of
Douglas Rad macher, Chair
WELD County
MAR 3 1 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)
o7D/4/- /D/O
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