Transcript of 180-10070-10154.pdf
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Assassination Records Review Board
Final Determination Notification
AGENCY HSCA
RECORD NUMBER 180-10070-10154
RECORD SERIES STAFF PAYROLL RECORDS
AGENCY FILE NUMBER
December 8, 1995
Status of Document: Postponed in Part
Number of releases of previously postponed information: 7
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 so substantial that it outweighs the interest:
Substitute Language: SSN
Date of Next Review: 2017
Board Review Completed: 10/24/95
Released under the JohnF KennedyAssassination kecords CollectionAct of T442 (44TSL
P1 Notel Casettilx 88326Date 2026
NW 88326
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Date:08 /20/93
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JFR ASSASSINATION SYSTEM
IDENTIFICATION FORM
AGENCY INFORMATION
AGENCY HSCA
RECORD NUMBER 180-10070-10154
RECORDS SERIES
STAFF PAYROLL RECORDS
AGENCY FILE NUMBER
DOCUMENT INFORMATION
ORIGINATOR HSCA
FROM
TO
TITLE
DATE 07/11/77
PAGES 7
SUBJECTS
HSCA ; ADMINISTRATION
SELLECK _ ELIZABETH KS
DOCUMENT TYPE PRINTED FORM
CLASSIFICATION U
RESTRICTIONS 3
CURRENT STATUS P
DATE OF LAST REVIEW 07/16/93
OPENING CRITERIA
COMENTS
Box 3 _
[R] ITEM IS RESTRICTED
NW 88326
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U.S. DEPARTMENT OF LABOR
EMPLOYMENT STANDARDS ADMINISTRATION_
0ffice 0f Workers ensation Programs
December 152 1978
File No : A25-146626
Date of Injury: May 25 , 1978
SSN: 531-50-7701
BS Ms. Elizabeth K: Selleck
4201 Cathedral Avenue
Washingion, CC; 20016
We need additional information to make a determination regarding the
claim you submitted for the injury indicated above Please furnish the
information requested in the items checked be low and on the reverse o f
this form. Use a separate sheet of papef numbering the answers to cor_
respond with the question numbers _
LX_ 1 The Federal Emp loyees Compensation Act requires
an injured
employee to written notice of injury to his/her supervisor
within 30 days . State why . this injury was not reported to
your supervisor within that time
2 _ Describe in
detail exactly how the injury occurred_ (For
example , if you fell, state how far you fell, how you Landed ,
etc _ If lifting was the cause of injury , describe: the object
handled, its weight, what you did with it, etc.).
X 3: Give the name $ of any persons who witnessed your injury or
had imediate knowledge of it_
S
incerely
bOEN PETTY
Ytz A
0
JR
Supervisory Claimg Examiner
select Canm: on Assassinations
HOuse of Representatives
OC #2
Washington, DC. 20515
Ltr CA-1O1l
Include address , ZIP code, and file number on
all correspondence June 1975
NW 88326
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give
Jour.
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4; State the immediate effects of: the injury and what you did immedi-
thereafter_
5_ Was: any other-injury suS tained, either on Or off between the
date. of: injury and the date it was first reported to (a ) your super-
visor and (1) to a doctor? If SO , describe:
X 6 _ State the. exact reason ~why you delayed seeking medical attention;
a Lso. the name and address of the doctor you first consulted
and the date, you were first examined for this injury:
7 _ Describe (a) your condition between the date .0f the injury and the
date you first received medical attention, and (b) the nature and
frequency of any home treatment :
8 _ Did you have any. similar disability
or symptoms before the injury? If
describe the prior condition_ Give the name s and addresses of the
physicians who treated you and the approximate dates , you were treated:
9 _ Did you ever file a claim for workers compensation benefits from
any source? If the date and nature of the injury, the name
and address of the office where the c laim was filed, and describe
the benefits (if any ) which you received:
10 . Arrange for submission of a medical report on the enc losed Form CA-20
from the private physician who examined you as a result of this injury_
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duty,
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S0 ,
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U.S. DEPARTMENT OF LABOR
EMPLOYMENT STANDARDS ADMINISTRATION
Office of Workers' Compensation Programs
December 15 , 1978 File No. : A25-146626
Date of Injury: May 25 , 1978
Employee Selleck Elizaketh K_
Noncontroverted Controverted
Select Com. on Assassinations
House Of Representatives
HOB #2
Washington, DC _ 20515
We have received Form CA-1 reporting an injury and your agency S response
to the evidence submitted_ It has been determined that:
The facts of the injury and employment support the employee
S
contention that he/she was a Federal employee who sustained
a
traumatic disab]ing injury in the performance of duty _ You
shou d therefore continue his/her pay_ for the period of dis-
ability not to exceed 45 days _
2 . The information 0f record is insufficient to make a decision on
the case however you should continue the emp]oyee S pay without
interruption. Additiona] information is required as noted on the
reverse of this letter_
3 _
1oer"ttX
TA
Ksqpe,-PEESYy ERMms
Examiner
Ms _ Elizabth K. Selleck
4201 Cathedral Avenue
Washington
1
DC_ 20016
Ltr CA-1038
Include your address, ZIP cde, and file number on all correspondence Rev_ Apr _ 1977
NW 88326
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C
SELLECK , Elizabeth OFFICE 0F THE CLERK
Mamo 6/ "Empioyce U.S, KOUSE 0F REPRESENTATIVES:
DALANCE Dhought
FonmikRo Tiom PERSONAL LEAVE RECORD pnecedixg XEri
Addrcss
Annejl Sick L178
[ad Laave
Ajaress YEA/
ANNUAL LeAVE
DaTE 0f AppointmenT
Phone Mumbcr CATEGORY
7-//1-77
1.0
Posilion Tiflu
Prior fEdeRAL scRvice
15
2.0 AcCRUED AvaiLAOLE USED Calancc
Fojiiioi Number Lcve} Sicp ;ionit;
This Montk This Moxth Tiiis Rohtk At Clcse 3
of ohttk
DAY OF MONTH Ancujl_ Sick Annwjl Sick Annual Sick Acaual Sick
2
1
Mcnth
T" 8 9 | 10 TTTTTTTT5" JgIn7 ] 8 19 20 | 21| 22 | 23 /. 24 25 | 26 / 27 / ?8 | 2 } 30 31 Leavc Leave Leayc Lcavc Lczye Leav: Lejv? leye
Jam
3
Feb.
Mar,
Apc,
May
Junc 3
July
XLXXKL 1zI 4T 12
Aug
Scpt;
Oct;,
MIa
7F1- |
Nov;
Dec,
= 0.5 day annual Ieaio CERTIFIED CORRECT;
= 1.0 day Jnnual Icjva
0,5 day sick Ieave
=1 sick Icavo Employco'& Sicnaturo Dufc Chial'$ Signatcre Dale
(I cmployec rcluscs (o sicn, stalc rcasan bclow =
0.5 administra(ive lejvo
10 day edminlstrallva Icavo Approvca:
Clcrk cf lhe Houso Daio
= 0.5 Uby unaulhorizcd Jascrco This rccord: will bc {criardcd to thc Clcrk Of thc Housc at thc cnd of cach cacndar ycar, or In casc of termination, along
= 1.0 day unjulhorizcd Jbscoco with tho requcst for tcrmination; Upon ?pproval, thc Iccord will bc filed in thc cmploycc'$ ollicial pcrsonncl (oldcr,
= 0.5. Icava withouf PaY
5 10 Icavc without Pay
EXHIBIT
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 0f Representatives:
hereby authorize the following payroll action:
Ewployee Name (First-Middle-Last) Effective Date
Elizateth Ko Selleck 7/15/78
Employee . Social Security Number Type 0f Action
Appointment
531-50-Z701 Salary Adjustment
Employing Ofiice or Committee /Subcommittee Title Change
Termination (At close of business on effective date)
Assassinatdons 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
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 J Clerical or Professional.
2_ Special (Investigative staff of Standing Committee) or Select Committee: Authority-_H. Res__ @EtiCongress
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 US.C, 3110b), prohibiting the employment of
relatives.
Date
July 7
19
73
(Signature of Official)
LQUIS STOKES
?
china
(If appropriate, signature of Subcommittee Chairman or Ranking Minority Member) (Type or print name of Authorizing Official)
(Type Or 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 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:
ID
Office Code.
Benefits
Monthly Annuity $_ 00
as of Payroll _
(Revised: August 1, 1977)
for: Initiating: Office or Committee
NW 88326
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956_of
Kajrin9int
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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
Elizabath 30 Selleck 7/11/77
Employee Social Security Number Type of Action
531 S0 7721
Appointment
Employing_Office_or_Committee Salary Adjustment
Termination (At close of business on effective date)
asgessinations
(If type of action is an Appointment or Salary Adjustment, complete the following information )
Position Title Gross Annual Salary
8tf2 Irvectigetoz 816,CoC
(If Committee Employee; complete appropriate item below:)
1 Standing Committee: Staff-[ Clerical or Professional:
2 Special or Select Committee: Authority-H Res._AS=
IIS
of
23thCongress.
3 Joint Committee_
(If Employee of an Officer of the House, complete item below:)
Position Number_ If applicable; Level
certify _ that this authorization is: not 'in violation of 5 U.S.C,. 3110b), prohibiting ` the employment of
relatives;
Date_ Jly_4l 1927_
(Signature of Authorizing Official)
Ipuig Stoted
ype or name of Authorizing Official)
Cras roa
(Title- If Member, District and State)
AAll 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:
b
Office Code_
Monthly Annuity $ 00
for Initiating Office or 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 A7owances and
Expenses 0f Committees
3
Members and Emplovees 0f the U,S House_of
Representatives requ re that
9
among other things the Commi ttee S
monthTy payroTT certification include the relationship, if any
3
0f
each employee to any current Member of Congress _ This fication
is S igned mon by our Cha irman_
The fo]]owing are the relationships to be inc]uded in the
certification:
father nephew brother-in-]al
mo ther niece sister-in-Iaw
son husband stepfather
daughter wife stepmother
brother father-in-Taw ste pbrother
sister mother-in-Iaw stepsister
unc]e son-in-]aW ha] f-brother
aunt daughter-in-]aw half-sister
first cousin
PTease complete the appropriate portion below, sign and date
this form, which WjlI then become a part of your permanent personne]
file_ If this status_changes
9
You must notify the Committee 5 Budget
Ofrice iediately of the_change:
1 an not related to any current (95th Congress) Member of Congress
I am related to a current (95th Congress) Member of Congress _
(PTease specify. )
(uqkxk Xul
Sigrla €uJe 0 f Emp Toyee
NW 88326
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for
certi
thly