HomeMy WebLinkAbout20143708.tiff COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
, COUNTY VETERANS SERVICE OFFICERS -MONTHLY REPORT AND CERTIFICATION OF PAY
• COUNTY OF WELD MONTH OCTOBER 2014
SECTION I: GENERAL INFORMATION
Telephone Calls 395 Correspondence Received 70
Office (Public Contacts) 446 Correspondence Written 75
Home Visits Information and Referral/Inquiries
Outreach Visits (i.e. NH...) Other(i.e: VCAA Notice Response)
Community Events/Forums 3 State Benefit(s) 10
Request for Medals 3 Request for Military Records &Corrections
Operation Recognition SF-180 16
DD 149 1
Request for Medical Treatment Records DD 293
21-4142 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 40 21-534
21-22 Other w/Accrued Benefits 1
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC - New/) 15 10-10 EZ 14
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)
21-4138 (SC -Increase) 8 10-7959a (CHAMPVA)
21.4138 (SC -Secansaryrnggmvmbn) 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
Non Service Connected Pension: VEAP CH 32
21-526 3 VN Era GI CH34
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 214502 (Auto Grant/Adaptive Equipment)
26-4555 (Housing Grant)
Request for Waivers/Compromise: 10-0103 (HISA Grant)
21-413tj Medicaid Application Assistance
5655(FSR) SSA Application Assistance
Other(Specify)
Dependent Indemnity Compensation (DIG) Other(Specify)
21.534 1 Other(Specify) VA boo/
w/Accrued Benefits 1 r+
Ort 5f, CC-VA CON) CVA-26(Revised Rom 1)
2014-3708
/O _ n , .,
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) 4 Requests wt 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
VA 9 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 (OCTOBER 2014 Weld County
Salary 4,894
Expenses
Office Space
Telephone 257.41
Office Supplies
Travel
Training Conference
Other
Other
Total 5,151
// / S- (i(
(Signature of County Veterans Service Officer) (Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance CRS 28-5-707 erebby�certify the accuracy of the Report(CVA-26, revised 8/2011):
kle)U/ County Commissioner or Designee of
1.
Weld County
DEC 01 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)
MO N1-370$
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