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# PAYROLL AUTHORIZATION FORM(Please Use Typewriter U.S. HOUSE OF REPRESENTATIVES (Any erasures, corrections, or changesor Ballpoint Pen) Washington, D.C. 20515 on this form must be initialed by theauthorizing official.)To the Clerk of the House of Representatives:I hereby authorize the following payroll action:| Employee Name (First-Middle-Last)          || ------------------------------------------ || Eileen G. Dinneen                          || Employee Social Security Number            || 462-88-1832                                || Employing Office or Committee/Subcommittee || Assassinations                             || Effective Date                                                      || ------------------------------------------------------------------- || 8/1/78                                                              || Type of Action                                                      || :-------------                                                      || Appointment                                                         || Salary Adjustment                                                   || Title Change                                                        || Termination (At close of business on effective date)                || ☐ Leave without pay (Beginning with effective date above and ending || close of business__Specifiy Date)                                   |(If type of action is an Appointment, Salary Adjustment, or Title Change, complete appropriate information below.)| Position Title | Gross Annual Salary* || -------------- | -------------------- ||                | $4,000.00            |*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 employeeplus 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. 956 of 95th Congress.3. ☐ Joint Committee..(If Employee of an Officer of the House, complete item below.)Position Number____ If applicable, Level____ Step____I certify that this authorization is not in violation of 5 U.S.C. 3110(b), prohibiting the employment of relatives.Date August 10 1978LOUIS STOKES, CHAIRMAN(Type or print name of Authorizing Official)(if appropriate, signature of Subcommittee Chairman or Ranking Minority Member)(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 employees, except those of the Committee on Appropriations, the Committee on the Budget, and the Joint Committees, mustbe approved by the Committee on House Administration..APPROVED:Chairman, Committee on House AdministrationOffice of Finance use only:Office CodeMonthly Annuity $______________.00 as of ___________Copy for Initiating Office or CommitteeID _____________Benefits ________Payroll __________ (Revised: August 1, 1977)NW 88326DocId:32243300 Page 8