HomeMy WebLinkAbout20140111.tiff COLORADO DEPARTMENT OFMILITARYAND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS-MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY:OF WELD. MONTH OE NOVEMBER�201a
i
SECTION. "I: GENERAL INFORMATION
Telephone Calls 572 Correspondence Received 70
Office(Public Contacts) 206 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 1
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( Z
I
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Ap ointed Representative: Death Pension/Widows Pension
21-22 CVA 14 21-534 1
21-22 Other w/Accrued Benefits 1
Claims for SC Entitlement: Request for VA Healthcare
21-526 (SC -New/) 8.. 10-10 EZ 12
21-4138 (SC-Informal Claim) ,3` 10-10 EZ-R 1
21-4138 (SC- New Issue) a 10-583
21-4138 , (SC-Reopen) 2 10-10d (CHAMPVA-Dependents) 3
21-4138 (SC-Increase) 4 10-7959a (CHAMPVA)
21-4138 (SC-Secondary/Ag ravetion) ,,10-7959C (CHAMPVA-Insurance Cert
21-4138 (SC- Reinstatement)
21-4138 (SC w/IU) Vocational Rehabilitation
21-8940 (IU) 284900 CH 31 1
21-4192 (IU - Employer) 28-1900 (Independent Living Program)
21-4138 (SMC) •
221-686c 5, 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) 1.
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) 2014-0111
21-534 Other(Specify)
w/Accrued Benefits
CVA-26(Revised 8/2011)
D!C VA- V/ oDO/
SECTION Il (Continued):
Burial Allowance Claims for Insurance
21-530 1 29-357
40-1330 2 29-4364 E
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 w/VTF(Grant),#Vets Assisted
26-1817 Rental Assistance
Utilities Assistance 200
Homeless Veterans Claims Filed Prescription Assistance/Other Medical
SC Food 1,500 .
NSC Transportation 500
Clothing
Incarcerated Veterans Other
21-4193 Release/Reinstatement
21-4138(Apportionment)
Appeals DRO Election
NOD 14 Review 2
VA 9 2 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 c NOVEMBER 2013 Weld County
Salary 4,187
Expenses
Office Space 1
Telephone 254.97
Office Supplies •
Travel
Training Conference
Other
Other
Total 4,442
)/ -1,K,-- / 3
(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):
\S� County Commissioner or Designee of
Doug1 s Rade acher, Chair
WELD County
IAN 1 3 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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