Transcript of 180-10060-10470.pdf
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Assassination Records Review Board
Final Determination Notification
AGENCY HSCA
RECORD NUMBER 180-10060-10470
RECORD SERIES STAFF PAYROLL RECORDS
AGENCY FILE NUMBER
December 8, 1995
Status of Document: Postponed in Part
Number of releases of previously postponed information: 6
Reason for Board Action: The Review Board's decision was premised on several factors
including: (a) the significant historical interest in the document in question; (b) the
absence of evidence that the release of the information would cause harm to the United
States or to any individual:
Number of Postponements: 3
Postponements: All the postponements in this document represent Social Security numbers:
Reason for Board Action: The text is redacted because the disclosure of the redaction could
reasonably be expected to constitute an unwarranted invasion of personal privacy, and that invasion of
privacy would be s0 substantial that it outweighs the interest:
Substitute Language: SSN
Date of Next Review: 2017
Board Review Completed: 10/24/95
xeibased under the Jahn
Kennedy Assassination
Records Collection Act of
1992 (44USC 2107 Note)
ase#Nw 88326Date:
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JFK ASSASSINATION SYSTEM
IDENTIFICATION FORM
AGENCY INFORMATION
AGENCY HSCA
RECORD NUMBER 180-10060-10470
RECORDS SERIES
STAFF PAYROLL RECORDS
AGENCY FILE NUMBER
DOCUMENT INFORMATION
ORIGINATOR HSCA
FROM
TO
TITLE
DATE 10/11/77
PAGES 7
SUBJECTS
HSCA ADMINISTRATION
LICHTENFELS BETH ANNE
DOCUMENT TYPE PRINTED FORM
CLASSIFICATION U
RESTRICTIONS 3
CURRENT STATUS P
DATE OF LAST REVIEW 06/04/93
OPENING CRITERIA
COMENTS
Box 2 _
[R] ITEM IS RESTRICTED
NW 88326
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PAYROLL Authorization FORM
(Please Use Typewriter
U.S. HOUSE- 0F. REPRESENTATIVES (Any; erasures; corrections: or changes
or Ballpoint Pen) Washington , D.C. 20515 0n this form must be initialed by (he
authorizing Official.)
To the Clerk 0f the House of Representatives:
hereby authorize the following payroll action:
Employee Name (First-Middle-Last) Effective Date
Beth Anae hiehtenfels Marek 10 1978
Employee Social Security Number Type of Action
042-52-8602 Appointment
EiSalary Adjustment
Employing Ofice or Committee/Subcommittee Title Change
Termination (At close of business on effective date)
Assaseiaarion8 Leave without pay (Beginning with effective date above and ending
close of business _
Specify Date
(If type of action is an_ Appointment, Salary-Adjustment, or Title Change, complete appropriate information- below:)
Position Title Gross Annual Salary
Docrert Coaero? Clerk 814 0800
If employee is a civil service annuitant (includes U.S. House of Representatives), the gross annual salary shown should include the annuity received by the employee
plus the salary received from the 'employing office.
(If Committee Employee, complete appropriate item below:)
1 Standing Committee: Staff Clerical or Professional:
2_ Special (Investigative staff of Standing Committee) or Select Committee: Authority-H. Res.25f1of_ ~9SECongress
3_ Joint Committee:
(If Employee of an Officer of the House, complete item below:)
Position Number If applicable, Level_ Step_
certify that this authorization is not. in violation of . 5 USC 3110b}, Prohibiting_the employment of:
relatives:
Date_ Maren_Hf 19_ J28
(Signature of Authorizing Official)
1023S S2022
(If appropriate, signature of Subcommittee Chairman or Ranking Minority Member)
Ype or print name of Authorizing Official)
Chefruz@_
(Type or print 'name and title of above official) (Title If Member, District and State)
All appointments and salary adjustments for employees under the House Classification Act and for Committee em-:
ployees, except those of the Committee on Appropriations, the Committee the Budget; and the Joint Committees, must
be approved by the Committee on House Administration.
APPROVED:_
Chairman, Committee on House Administration
Office of Finance use only:
ID
Office Code.
SS- Benefits
Monthly Annuity S__ .00 as of Payroll _
(Revised: August 1, 1977)
for: Initiating Officeror Committee
NW 88326
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M E M 0 R A N D U M
To: ALL STAFF
RE: Payro]1 Certification
The Regulations and Accounting Procedures for A]owances and
Expenses_ 0f Committees
)
Members and Employees of the U.S. House_of
Representat ves require that, among other things the Committee S
mon thly payroTT certification inc]ude the relationship, if any
9 _
of
each employee to any current Member of Congress _ This certification
is signed monthly .by our Cha irman_
The fo] owing
are the relationships to be included in the
certification:
father nephew brother-in-Iaw
mother niece sister-in-Iaw
son husband stepfather
daughter wife stepmother
brother father-in-Iaw stepbrother
sister mother-in-Iaw stepsister
unc]e son-in-]aw hal f-brother
aunt daughter-in-Iaw half-sister
first cousin
PTease comp]ete the appropriate portion below
9
sign and date
this form, which Wi]] then become a part of your permanent personnel
file_ If this status changes you must notifv the Committee S Budget
Office immediately 0f the change
I am not related to current (95th Congress) Member of Congress._
[ am related to a current (95th Congress) Member of Congress
(PTease specify. )
4
ZtLL_
DA_4222
Signa ture of EmpToyee Date
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M € M 0 R 4 N D W M
TO : Tom Howarth_ Budget Officer
d,el
FROM: Charlie Mathews Special Counsel
DATE : October 5; 1977
RE: Ms _ Beth AnneLichtenfels
Ms Beth AnneLichtenfels has accepted the position
of Document Control Clerk with the: John F_ Kennedy Task
Force Her effective starting date will be October X , 1977 ,
and her starting salary will be $12,000 . 00 _
Your full co-operation will be appreciated in familiarizing
Ms Lichtenfels with staff procedures and welcoming her
aboard _
ICM:jl
NW 88326
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PAYROLL AUTHORIZATiON FORM
(Please Use:Typewriter: U.S. HOUSE 0F REPRESENTATIVES; (Any erasures, corrections, or changes_
or Ballpoint Pen}: Washington; D.C: 20515 on this form must be. initialed .by the
authorizing Official.)
To the Clerk of the House of Representatives:
hereby authorize the following payroll action:
Employee Name First-Middle-Last) Effective Date
Beth Anne Lichtenfels October 11 , 1977
Employee Social Security Number Type of Action
042-52-4602
TJr Appointment
Employing_Office_Or_Committee Salary Adjustment
Assassinattons Termination (At close of business on effective date)
(If type of action is an Appointment or Salary Adjustment; complete the following information:)
Position Title Gross Annual Salary
Docunent Contro] Clerk 812,000.80
(If Committee Employee, complete appropriate item below:)
1 Standing Committee: Staff_ Clerical or Professional:
2.
Special or Select Committee: Authority-H. Res__465
of_
95th_Congress.
3 Joint Committee:
(If Employee of an Officer of the House, complete item below:)
Position Number_ f applicable, Level_ Step_
certify that this authorization is not in violation of .5 U,S:C: .3110b), prohibiting the: employment of
relatives.
Date_
October_1] 1922
(Signature of Authorizing Official)
Lquis_Stokes
(Type or print name of Authorizing Official)
Chelnan_
(Title ~ If Member, District and State)
All appointments and salary adjustments for employees under-the: House Classification Act and for Committee-em-:
'ployees; except those of the Committee on Appropriations; the Committee on. the Budget;'and the Joint Committees; must
be approved by the Committee on House Administration:
APPROVED:_
Chairman Committee on House Administration
Office of Finance Use only:
Office Code_
Monthly Annuity $_
for -Initiating Office Om Committee
NW 88326
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Ner MrM
200#GX
OFFICIAL SUPERIOR'S REPORT OF TRAUMATIC INJURY GaoXait
0 0efs Prt4 21, Department or _Agency 22: Bureau_or Office
HOUSE OF REPRESENTATIVES SELECT: COMMITTEE_ ON ASSASSINATIONS
23. Name and Address of Reporting Office (No:;' street; state , Zip Code)
HOUSE ANNEX #2, 3rd AND' D STREET WASHINGTON DC
24. Regular Work 25. Number Of Kours 26.Circle Days Paid Per Wcek
Am AM Worked Per
Begins Ends S S PM PM
27. Date and Hour_of Lnjury 28, Date Reporting Office 29. Date and Hour Stopped 30. If Kas Been Terrriinated,
(moz, day , vear) Received Notice of Injury Work Zus Oi 36
Give Date
860
AM: (mos; day; Yeart (no:
7/19/78
(3918y+3ar}
Pm:
31.45 Day Period Begins 32. Rate When Employeel 33. Date and Hour Employee Returned 34. Narne of Supervisor At Tire of
03 (mox, day: year}; Stopped Work to Work: Injury
64 year} #l4 AM fx O.ju0n 624 '(mo_ day _
9 7 19/78 'jye&
Houonery
S per PM
35. Was Employee In Performance of Duty At The Time of Injury? Yes, No. If Furnish A Detailed Explanation Or A Copy
of Emploving Agency'8 Investigation Report_
vug446[oauMe 3 77G Nov;
Mnpw; Tc 0Sucixeleerom Udcnumuuoncenow yesp gep Neejca
'ONSM9? Ev?pViQWj86aui043# 648 04e 3R Gonu8ts;;
0uul 46
36. Was Injury Caused By Willful Misconduct, Intoxication or-Intent To Injure Self or Another?
Yes No. If Furnish Detailed Report.
37. Was Injury Caused By Third Party? _ Yes LNo: If. Furnish Name and Addressof_Party Responsible._
TTIU Co IJd; poniscj
Isccua OS1E1- #L6 Ifi
GnEE I5
38. Date Employee First Obtained . 39. Name and Address of Physician First Providing Medical Care 40. Do Medical Reports Showv
Medical Care for The Injury {St Employee is Disabled For
(mo., day, year)anz vj: SUBURBAN HOSPITAL EMERGENCY ROOM; Nk Work 4
7/19 78 BETHESDA; MARYLAND
~6
Yes No
41. Does Your Knowledge of The Facts About This Injury Agree With_The Statements of The Employee And/OrWitness?_
Yes No. If Furnish A Detailed Explanation.
IEGL
42. Does The Employing Agency Controvert Continuation of Pay? Yes No. If Yes; Give Full Explanation For Basis of
Controversion (See tem 6 of Instruction Sheet) _ Attach Additional Sheets If More Space Is Needed.
43.Signat of Supervisor) 44. Title and Office Phone Number 45. Date (mo , day , year). Eora7yeh)
Budg_iftry
1ws->98. 7->7-75
NW 88326
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0143:
city ,
Day
Day
Pay
day; year)
Pay
No,
4{0 #8
867
Yes,
Yes,
No,
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U.S. DEPARTMENT OF LABOR
FEDERAL EMPLOYEE'S Notice OF TRAUMATIC injury
EMPLOYMENT STANDARDS ADMINISTRATION
AND CLAIM For CONTINUATION OF PAYICOMPENSATION
QFFICE OF WORKERS' COMPENSATION PROGRAMS
1, Name of Injured Employea (Last, first, middle) 2. Date of Birth 3. Male 4. Social Security Number
LICHTENFELS _ BETH ANNE 1/5/55 042-52-4602
Female
5. Employee's Home Mailing Address (No , street, city, state, zip code) 6. Home Telephone
4401 EAST- WEST: HGWY 'BETHESDA MD _ APT 300 Area Code: 301
Number: 654-7184
7 Name and Address of Employing Agency 8. Place Where Injury Occurred (e-g-, Znd floor, Maln Post Office
House SELECT COMM. ON ASSASSINATIONS Bldg-, 12th & Pine)
3rd AND D STREET , S.W _ Znd AND C STREET
WASHINGTON D WASHINGTON D_ C.
9.Date and Hour Of Injury 410.Date of This Notlce Dependents 2.Employee'$
(mo., day, Year) AM (mos, day , year) Wife/Husband Occupation
7/17/78
KlPm 7/27/78 Children Under 18 Years Old poc _ Clerk
13. Cause of Injury (Describe how and why the injury occurred)_ 14. Nature %f Injury (Identify the part of the body injured, e.g-.
0 fractured left leg, etc_)
Fall was 'caused by: faulty shoe
Yc6 C0
strap which--broke-and-tripped Partially -separated right shoulder
injured employee torn rotating cuff torn and bruised:
tendons ,
0
ligaments and muscles _ Skin
burn to right shoulder
15. If This Notice and Claim Was Not Filed With-The Employing Agency-Within 2 Working Deys After The Injury, Explain The Reason
For The Delay.
KD- 14 400 NmhmhD6eweq #xi
4 44On4E Co CA oiem
16. certify that the injury described above was sustainad in performance of duty as an emplovee of the United States Government &d that
it was not caused by my willful misconduct, Intent to injure myself or another person, nor by my intoxication. hereby claim medical
treatment, if needed; and the following, 88 checked below, while disabled for Work:
Mpelahcu GK6
a; Sick andlor annual Iaave Li6o{ 07 io 380202 Ui}
b. Continuation of regular pay not to exceed 45 days ad compensation for wage Ioss If disability for work continuee beyond 45
days (4f my claim is denled , understand that the continuation of my regular pay shall be charged to sick or annual leave, or
be deemed an overpayment within the meaning of 5 USC 6584):
L.5 As Zza
Uzl2
Signature of Employee or Person Acking on His/Her Behalf
:l 014" 17. Statement of Witnass (Describe What Vou saw, heard or know about this injury)
2#
E ti Juoi 6
acielmc pet Yirpercrk
0ra
#opee duny 452HIMCion
761B0Leg; TeekePaLiie We {B Koq
Ed6
Genzp 'RrRcI COwIz LZS Oi 1228231MSilo
3,8 1'15
18. Witness
Signatura
4g. Witnass'Address _ "n 4CNtcs 20.Date Signed
elicis ZWEvipk dEbouiobilbrnwxicinnb
Imo , day, Year)
Form CA-]
Rev. Nov. 1974
NW 88326
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Lous STOKE9; Okio; CHAIRMAN
RICkARDSON prEYER, Nc BAMUEL L: DEvine, Oxio
WaLTeR E= FAUNTROY, Dc: STEwART 0: MCKINNEY , CoNm:
YVONNE BRATHWAITE Burke; CALPe CHARLES THIONE, NeBR:
christopher :J: DODD; CONN: MAROLD I. SAWYER, Mick:
NAROLD 6' 'FORD: TENN:
FLOYD J. FITHIAN; IND:
Select Commiltee Ot @ssassinations
ROBERT W. EDGAR, PA:
(202) 223-4824
4.8. {boiise of RRepresentatibes
3331 HOUSE OFPICE BUILDING, ANNEX 2
WASKINGTON, DC. 20515
September 25
#
1978
Office of Workers Compensation Programs
Special Claims Unit
711 14th Street, N e' W
Washington, De C . 20211
Dear Sirs:
We are
forwarding herewith Forn CA-1 for Beth C
Lichtenfels an employee of this Committee_ We apologize
for the late filing but we mis-reaa the instructions
While Miss Lichtenfels did not require sick or annual
leave and the Committee did not controvert continuation
Of pay , she did require medical treatment
In the meantime we filed her Form CA-l in her per-
sonnel file_
Sincerely yours_
Hn{ra5/
THOMAS HOWARTH
Budget Officer
TH:ht
NW 88326
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