Assassination Records Review Board
Final Determination Notification
AGENCY :
HSCA
RECORD NUMBER :
180-10068-10324
RECORD SERIES : STAFF PAYROLL RECORDS
AGENCY FILE NUMBER :
December 8, 1995
Status of Document:
Postponed in Part
Number of releases of previously postponed information: 8
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: 4
Postponements: All the postponements in this document represent Social Security numbers.
Reason for Board Action: The text is redacted because the public 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 public interest.
Substitute Language: SSN
Date of Next Review: 2017
Board Review Completed: 10/24/95
'NW 88326
Docld:32243290 Page 1
Released under the John F. Kennedy Assassination Records Collection Act of 1992
44 USC 2107 Notel. Case#:NW 88326 Date: 2025
JFK ASSASSINATION SYSTEM
IDENTIFICATION FORM
AGENCY INFORMATION
Date: 08/20/93
Page: 1
AGENCY: HSCA
RECORD NUMBER :
180-10068-10324
RECORDS SERIES :
STAFF PAYROLL RECORDS
AGENCY FILE NUMBER :
ORIGINATOR : HSCA
FROM:
TO :
TITLE :
DOCUMENT INFORMATION
DATE : 12/29/77
PAGES: 8
SUBJECTS :
HSCA, ADMINISTRATION
COLLINS, WENDY S.
DOCUMENT TYPE :
PRINTED FORM
CLASSIFICATION : U
RESTRICTIONS : 3
CURRENT STATUS: P
DATE OF LAST REVIEW : 07/07/93
OPENING CRITERIA :
Box #:1.
COMMENTS
NW 88326
Docld:32243290 Page 2
[R]
-
ITEM IS RESTRICTED
LOUIS STOKES, OHIO, CHAIRMAN
RICHARDSON PREYER, N.C.
YVONNE BRATHWAITE BURKE, CALIF.
WALTER E. FAUNTROY, D.C.
CHRISTOPHER J. DODD, CONN.
HAROLD E. FORD, TENN.
FLOYD J. FITHIAN, IND.
SAMUEL L. DEVINE, OHIO
STEWART B. MCKINNEY, CONN.
CHARLES THONE, NEBR.
HAROLD S. SAWYER, MICH.
ROBERT W. EDGAR, PA.
(202) 225-4624.
Select Committee on Assassinations
U.S. House of Representatives
3369 HOUSE OFFICE BUILDING, ANNEX 2
WASHINGTON, D.C. 20515
December 5, 1978
The Honorable Frank Thompson, Jr.
Chairman
Committee on House Administration
U. S. House of Representatives
Washington, D. C. 20515
Dear Mr. Chairman:
Effective December 1, 1978, the official duty station of Ms. Wendy
Collins has been changed from Washington, D. C. to Pittsford, Vermont.
This change will remain in effect through the balance of the 95th Congress.
LS: th
NW 88326
Docld:32243290 Page 3
Sincerely.
LOUIS STOKES
Chairman
PAYROLL AUTHORIZATION FORM
(Please Use Typewriter
or Ballpoint Pen)
U.S. HOUSE OF REPRESENTATIVES-
Washington, D.C. 20515
To the Clerk of the House of Representatives:
I hereby authorize the following payroll action:
Employee Name (First-Middle-Last)
(Any erasures, corrections, or changes
on this form must be initialed by the
authorizing official.)
Effective Date
December 20, 1978
Hendy S. Collins
Employee Social Security Number
024-44-5143
☐ Appointment
☐ Salary Adjustment
Employing Office or Committee/Subcommittee
Assassinations.
☐ Title Change
Type of Action
☐ Termination (At close of business on effective date)
☐ 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 -☐ Clerical or ☐ Professional.
2.
Special (Investigative staff of Standing Committee) or Select Committee: Authority-H. Res. of 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.
December 11, 1978
Date___
19___
(If appropriate, signature of Subcommittee Chairman or Ranking Minority Member)
(Type or print name and title of above official)
(Signature of Authorizing Official)
LOUIS STOXES
(Type or print name of Authorizing Official)
Chairman
(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.
Office of Finance use only:
NW 88326
APPROVED:..
Chairman, Committee on House Administration
ID
Office Code
Monthly Annuity $.
.00
as of
Benefits
Payroll.
Copy for Initiating Office or Committee
(Revised: August 1 1977)
Docld:32243290 Page 4
PAYROLL AUTHORIZATION FORM
(Please Use Typewriter
or Ballpoint Pen)
U.S. HOUSE OF REPRESENTATIVES™
Washington, D.C. 20515
To the Clerk of the House of Representatives:
I hereby authorize the following payroll action:
Employee Name (First-Middle-Last)
(Any erasures, corrections, or changes
on this form must be initialed by the
authorizing official.)
Effective Date
Hendy S. Collins
Employee Social Security Number
December 29,
0
1977
Type of Action
024-44-5163
Employing Office or Committee/Subcommittee
Assassinations
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 _ _
Specify Date
(If type of action is an Appointment, Salary Adjustment, or Title Change, complete appropriate information below.)
Position Title
Research Attorney
Gross Annual Salary*.
$18,000
* 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. of 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_
December 29.
1971
Gack
(Signature of Authorizing Official)
Louis Stokes
(If appropriate, signature of Subcommittee Chairman or Ranking Minority Member)
(Type or print name of Authorizing Official)
Gaines
(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 on the Budget, and the Joint Committees, must
be approved by the Committee on House Administration.
Office of Finance use only:
APPROVED:
Chairman, Committee on House Administration
ID
Office Code
Monthly Annuity $_.
.00
as of
Benefits
Payroll
Copy for Initiating Office or Committee
(Revised: August 1 1977)
NW 88326
Docld:32243290 Page 5
0
0
0 0
US. GOVERNMENT PRINTING OFFICE: 1976-599-393
If typewriter is not available, bear down with ball-point pen to make legible copies.
HEALTH BENEFITS REGISTRATION FORM
FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
(Read instructions on back of page 3.)
TO EMPLOYING OFFICE: SHOW OLD CARRIER'S CONTROL NUMBER ONLY IF ELECTION IS TO CANCEL
ENROLLMENT OR TO CHANGE OPTIONS OR TYPE OF ENROLLMENT IN THE SAME PLAN.
(LAST)
Collins
1. NAME
PART A
ALL WHO REGIS-
TER MUST FILL
IN THIS PART. ~
(CITY)
4. YOUR MAILING ADDRESS
(FIRST)
WENDY
Wen
(NUMBER AND STREET)
1630 Hobart
(STATE)
WASHINgton
St., N.W.
D.C...
(ZIP CODE)
(MIDDLE INITIAL)
2. DATE OF BIRTH
20009
IMPORTANT
S
MONTH
03
(Use numbers)
DAY
YEAR
2253
5. SOCIAL SECURITY
ACCOUNT NUMBER
024-44-5/63
New Carrier's Control No.
1336
22933820
Old Carrier's Control No.
3. ARE YOU NOW
MARRIED?
Yes
1
No
6. SEX
MALE
FEMALE
IT IS ILLEGAL FOR AN EMPLOYEE OR A MEMBER OF HIS FAMILY TO BE COVERED UNDER MORE THAN ONE ENROLLMENT. IF YOU ARE ALREADY COVERED THROUGH
THE FAMILY ENROLLMENT OF ANOTHER FEDERAL OR DISTRICT OF COLUMBIA EMPLOYEE OR ANNUITANT YOU MUST REGISTER NOT TO ENROLL OR THE OTHER
ENROLLMENT MUST BE CANCELED OR CHANGED TO SELF ONLY. SIMILARLY, IF A FAMILY MEMBER LISTED BY YOU IN PART B IS COVERED THROUGH HIS (OR HER) OWN
ENROLLMENT, YOU CANNOT ELECT A FAMILY ENROLLMENT UNLESS THE FAMILY MEMBER CANCELS HIS (OR HER) ENROLLMENT. ALSO SEE BACK OF PAGES 2 AND 3.
1. 1 elect to enroll in a health benefits plan as shown below. I authorize deductions from my salary, compensation, or annuity to cover my
PART B
share of the cost of the enrollment. (Copy the information requested below from back page of brochure of the plan you select.)
NAME OF PLAN
ENROLLMENT CODE NUMBER
FILL IN THIS
PART IF YOU
WISH TO ENROLL
OR CHANGE
YOUR ENROLL-
MENT IN A
HEALTH. BENE-
.FITS PLAN.
If enrollment is
for Self Only,
answer item 1.
If enrollment.is.
for Self and.
Family, also an
swer item 2.
IF YOU ARE
CHANGING YOUR
ENROLLMENT
ALSO FILL IN
PART D.
Blue Cross/Blue Shield Service
Benefit PLAN
OPTION (HIGH OR LOW)
HIGH
110
2. In space below list all eligible family members without exception: List your wife or husband first, then your unmarried children under age
22, including (a) legally adopted children and (b) stepchildren, foster children, and illegitimate children who live with you in a regular
parent-child relationship. Include also any unmarried child over 22 who became disabled before age 22 and who, because of the disability,
is incapable of self-support. (Attach a doctor's certificate for a disabled child age 22 or over, if one is not already on file.) DO NOT LIST
PARENTS OR OTHERS WHO ARE NOT ELIGIBLE FAMILY MEMBERS. THEY WILL NOT RECEIVE BENEFITS, EVEN IF THEY
ARE DEPENDENT ON YOU AND ARE LISTED.
Wife or
Husband
NAMES OF FAMILY MEMBERS
DATE OF BIRTH'
(Month, Day, Year)
1
3
4
5
NAMES OF FAMILY MEMBERS
DATE OF BIRTH
(Month, Day, Year)
6
7
8
9
. PART.C
FILL IN THIS
PART IF YOU
WISH NOT TO
ENROLL OR IF
YOU WISH TO
CANCEL YOUR
ENROLLMENT.
PART D
FILL IN THIS
PART, AS WELL
AS PART B, TO
CHANGE YOUR
REGISTRATION.
PART E
ALL WHO REGIS
TER MUST FILL
IN THIS PART.
PART F
TO BE
COMPLETED
BY AGENCY
PLACE AN "X" IN ITEM 1 OR 2 WHICHEVER APPLIES:
1.
I ELECT NOT TO ENROLL IN A PLAN UNDER THE FEDERAL
EMPLOYEES HEALTH BENEFITS PROGRAM:
2:
I ELECT TO CANCEL MY PRESENT ENROLLMENT UNDER THE
CODE NUMBER SHOWN BELOW.
Present Enrollment Code Number.
If you elect to cancel
be sure to read
"Cancellation of Enroll-
ment" on back of page 3.
ANSWER ITEMS 1, 2, AND 3 TO SHOW ENROLLMENT CODE BEING CHANGED AND ELIGIBILITY FOR CHANGE.
.1. ENROLLMENT CODE NUMBER:
OF PRESENT-PLAN
Wendy
SC
(YOUR SIGNATURE. DO NOT PRINT)
2., NUMBER OF EVENT WHICH PERMITS CHANGE: 3. DATE OF EVENT WHICH PERMITS CHANGE.
(See table on back of page 2 for proper number.).
Aug 5, 1978
(DATE)
1. NAME AND ADDRESS (INCLUDING ZIP CODE) OF EMPLOYING OFFICE
U.S. House of Representatives
Office of Finance, Washington, D.C.
MONTH
DAY
YEAR
WARNING.-Any intentional false statement
in this application or wilful misrepresentation
relative thereto is a violation of the law
punishable by a fine of not more than $10,000
or imprisonment of not more than 5 years,
or both (18 U.S.C. 1001.)
2. DATE RECEIVED IN
EMPLOYING OFFICE
3. EFFECTIVE DATE OF
ELECTION
20515
4. PAYROLL OFFICE NO.
5. SF 2811 REPORT NO.
(SIGNATURE OF AUTHORIZED AGENCY OFFICIAL)
REMARKS
FOR USE ONLY
BY AGENCY.
NW 88326
Docld:32243290 Page 6
Page 1
-
.00004832
To Payroll Office
Standard Form No. 2809
U.S. Civil Service Commission,
FPM Supplement 890-1
November 1972
If typewriter is not available, bear down with ball-point pen to make legible copies.
HEALTH BENEFITS REGISTRATION FORM
FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
(Read instructions on back of page 3.)
TO EMPLOYING OFFICE: SHOW OLD CARRIER'S CONTROL NUMBER ONLY IF ELECTION IS TO CANCEL
ENROLLMENT OR TO CHANGE OPTIONS OR TYPE OF ENROLLMENT IN THE SAME 
PLAN.
New Carrier's Control No.
22933820
Old Carrier's Control No
PART A
ALL WHO REGIS-
TER MUST FILL
IN THIS PART.
1. NAME
(LAST)
Collins
(FIRST)
Wendy
4. YOUR MAILING ADDRESS. (NUMBER AND STREE(T)
1630 Hobart.
(CITY)
WA
(STATE)
St., N.W.
ASHiNgton DC.
(ZIP CODE)
S
MONTH
(MIDDLE INITIAL)
2. DATE OF BIRTH
(Use numbers)
3. ARE YOU NOW
MARRIED?
DAY
YEAR
22
53
Yes
No
6. SEX
MALE
1
20009
IMPORTANT
03
5. SOCIAL SECURITY
ACCOUNT NUMBER)
024-44-5/63
FEMALE
IT IS ILLEGAL FOR AN EMPLOYEE OR A MEMBER OF HIS FAMILY TO BE COVERED UNDER MORE THAN ONE ENROLLMENT. IF YOU ARE ALREADY COVERED THROUGH
THE FAMILY ENROLLMENT OF ANOTHER FEDERAL OR DISTRICT OF COLUMBIA 
EMPLOYEE OR ANNUITANT YOU MUST REGISTER NOT TO ENROLL OR THE OTHER
ENROLLMENT MUST BE CANCELED OR CHANGED TO SELF ONLY. SIMILARLY, IF A 
FAMILY MEMBER LISTED BY YOU IN PART B IS COVERED THROUGH HIS (OR HER) OWN
.
ENROLLMENT, YOU CANNOT ELECT A FAMILY ENROLLMENT UNLESS THE FAMILY 
MEMBER CANCELS HIS (OR HER) ENROLLMENT. ALSO SEE BACK OF PAGES 2 AND.3.
1. 1 elect to enroll in a health benefits plan as shown below. I authorize deductions from my salary, compensation," or annuity to cover my
share of the cost of the enrollment. (Copy the information requested below from back page of brochure 
of, the plan you select.)
NAME OF PLAN
PART B
FILL IN THIS
PART IF YOU
WISH TO ENROLL
OR CHANGE
YOUR ENROLL-
MENT IN A
HEALTH BENE-
FITS PLAN..
If enrollment is
for Self Only,
answer item 1:
If enrollment is
for Self and
Family, also an
swer item 2.
IF YOU ARE
CHANGING YOUR
ENROLLMENT
ALSO FILL IN
PART D
PART C
Blue (Ross/Blue Shield Service
Benefit
PLAN
OPTION (HIGH OR LOW)
HIGH
ENROLLMENT CODE NUMBER
10%
2. In space below list all eligible family members without exception: List your wife or husband first, then your unmarried children under age
22, including (a) legally adopted children and (b) stepchildren, foster 
children, and illegitimate children who live with you in a regular
parent-child relationship. Include also any unmarried child over 22 
who became disabled before age 22 and who, because of the disability,
is incapable of self-support. (Attach a doctor's certificate for a disabled 
child age 22 or over, if one is not already on file.) DO NOT LIST
PARENTS OR OTHERS WHO ARE NOT ELIGIBLE 
FAMILY MEMBERS. THEY WILL NOT RECEIVE BENEFITS, EVEN IF THEY
ARE DEPENDENT ON YOU AND ARE LISTED.
Wife or
Husband
NAMES OF FAMILY MEMBERS
DATE OF BIRTH
(Month, Day Year)
PLACE AN "X" IN ITEM 1 ÖR.2 WHICHEVER APPLIES.
FILL IN THIS
1. I ELECT NOT TO ENROLL IN A PLAN UNDER THE FEDERAL
EMPLOYEES HEALTH BENEFITS PROGRAM
PART IF YOU
2
4
5
NAMES OF FAMILY MEMBERS
DATE OF BIRTH
(Month, Day, Year!
.6
2. ELECT TO CANCEL MY PRESENT ENROLLMENT UNDER THE
CODE NUMBER SHOWN BELOW:
7
8
9
10
WISH NOT TO
ENROLL OR IF
YOU WISH TO
CANCEL YOUR
ENROLLMENT..
PART D
FILL IN THIS
PART, AS WELL
AS PART B, TO
CHANGE YOUR
REGISTRATION.
PART E
ALL WHO REGIS-
TER MUST FILL
IN THIS PART.
Present Enrollment Code Number
ANSWER ITEMS 1, 2, AND 3 TO SHOW ENROLLMENT CODE BEING CHANGED AND ELIGIBILITY FOR CHANGE.
1
ENROLLMENT CODE NUMBER
OF PRESENT PLAN
We
(YOUR SIGNATURE. DO NOT PRINT)
2. NUMBER OF EVENT WHICH PERMITS CHANGE.
(See table on back of page 2 for proper number.)
Aug 5, 1978
(DATE)
1. NAME AND ADDRESS (INCLUDING ZIP CODE) OF EMPLOYING OFFICE
If you elect to cancel
be sure to read
"Cancellation of Enroll-
ment" on back of page 3.
3. DATE OF EVENT WHICH PERMITS CHANGE.
MONTH
DAY
YEAR
WARNING. Any intentional false statement
in this application or wilful misrepresentation
relative thereto is a violation of the law
punishable by a fine of not more than $10,000
or imprisonment of not more than 5 years,
or both (18 U.S.C. 1001.)
2. DATE RECEIVED IN
EMPLOYING OFFICE
3. EFFECTIVE DATE OF
ELECTION
PART F
TO BE
COMPLETED
BY AGENCY
U.S. House of Representatives
Office of Finance, Washington, D.C. 20515
4. PAYROLL OFFICE NO...
REMARKS
FOR USE ONLY
BY AGENCY.
NW 88326-
Docld:32243290₁:Page 7°
(SIGNATURE OF AUTHORIZED. AGENCY OFFICIAL)
Page 2 - To Insurance Carrier
00004832
5. SF 2811 REPORT NO.
Standard Form No. 2809
U.S. Civil Service Commission
If typewriter is not available, bear down with ball-point pen to make legible copies.
HEALTH BENEFITS REGISTRATION FORM
FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
(Read instructions on back of page 3.)
TO EMPLOYING OFFICE: SHOW OLD CARRIER'S CONTROL NUMBER ONLY IF ELECTION IS TO CANCEL
ENROLLMENT OR TO CHANGE OPTIONS OR TYPE OF ENROLLMENT IN THE SAME PLAN.
0
New Carrier's Control No.
22933820
Old Carrier's Control No.
1. NAME
(LAST)
(FIRST)
PART A
ALL WHO REGIS-
Colling
TER MUST FILL 163 Hobart
IN THIS PART.
4. YOUR MAILING ADDRESS
(NUMBER AND STREET)
(CITY)"
(STATE).
SP, N.W
(ZIP CODE)
(MIDDLE.INITIAL)
2000
IMPORTANT
S
2. DATE OF BIRTH
(Use numbers)
MONTH
DAY
YEAR
22 S3
5. SOCIAL SECURITY
3. ACCOUNT NUMBER
3. ARE YOU NOW
MARRIED?
1
Yes
Not
2
6. SEX
MALE
1
FEMALE
IT IS ILLEGAL FOR AN EMPLOYEE OR A MEMBER OF HIS FAMILY TO BE COVERED UNDER MORE THAN ONE ENROLLMENT. IF YOU ARE ALREADY COVERED THROUGH
THE FAMILY ENROLLMENT OF ANOTHER FEDERAL OR DISTRICT OF COLUMBIA EMPLOYEE OR ANNUITANT YOU MUST REGISTER NOT TO ENROLL OR THE OTHER
ENROLLMENT MUST BE CANCELED OR CHANGED TO SELF ONLY. SIMILARLY, IF A FAMILY MEMBER LISTED BY YOU IN PART B IS COVERED THROUGH HIS (OR HER) OWN
ENROLLMENT, YOU CANNOT ELECT A FAMILY ENROLLMENT UNLESS THE FAMILY MEMBER CANCELS HIS (OR HER) ENROLLMENT. ALSO SEE BACK OF PAGES 2 AND 3.
1. I elect to enroll in a health benefits plan as shown below. I authorize deductions from my salary, compensation, or annuity to cover my..
PART B
share of the cost of the enrollment. (Copy the information requested below from back page of brochure of the plan you select.)
NAME OF PLAN
FILL IN THIS
PART IF YOU Crus/Blue Shield Sea
WISH TO ENROLL
OR CHANGE
YOUR ENROLL-
MENT IN A
HEALTH BENE-
FITS PLAN.
If enrollment is
for Self Only,
answer item 1.
If enrollment is,
for Self and
Family, also an-
swer item 2.
Bewert
•PLAN.
Vie
OPTION (HIGH OR LOW)
HIGH
ENROLLMENT CODE NUMBER
70%
2. In space below list all eligible family members without exception: List your wife or husband first, then your unmarried children under age
22, including (a) legally adopted children and (b) stepchildren, foster children, and illegitimate children who live with you in a regular
parent-child relationship. Include also any unmarried child. over 22 who became disabled before age 22 and who, because of the disability,
is incapable of self-support. (Attach a doctor's certificate for a disabled child age 22 or over, if one is not already on file.) DO NOT LIST
PARENTS OR OTHERS WHO ARE NOT ELIGIBLE FAMILY MEMBERS. THEY WILL NOT RECEIVE BENEFITS, EVEN IF THEY
ARE DEPENDENT ON YOU AND ARE LISTED.
☐ NAMES OF FAMILY MEMBERS.
Wife or
Husband
DATE OF BIRTH
(Month, Day, Year)
.2
NAMES OF FAMILY MEMBERS
DATE OF BIRTH
(Month, Day, Year)
6
7
IF YOU ARE
CHANGING YOUR
ENROLLMENT
ALSO FILL: IN
PART D.
_ PART C
FILL IN THIS
PART IF YOU
WISH NOT TO
ENROLL OR IF
YOU WISH TO
CANCEL YOUR
ENROLLMENT.
PART D
FILL IN THIS
PART, AS WELL
AS PART B. TO
CHANGE YOUR
REGISTRATION.
PART E
ALL WHO REGIS-
TER MUST FILL
IN THIS PART.
PLACE AN "X" IN ITEM 1 OR 2 WHICHEVER APPLIES:
1. ELECT.NOT TO ENROLL IN A PLAN UNDER THE FEDERAL
EMPLOYEES HEALTH BENEFITS PROGRAM.
4
5
2. I ELECT TO CANCEL MY PRESENT ENROLLMENT UNDER THE
CODE NUMBER SHOWN BELOW. **
Present Enrollment Code Number
ANSWER ITEMS 1, 2, AND 3 TO SHOW ENROLLMENT CODE BEING CHANGED AND ELIGIBILITY FOR CHANGE:
1. ENROLLMENT CODE NUMBER
OF PRESENT PLAN
Wer
S
(YOU'R SIGNATURE. DO NOT PRINT)
If you elect to cancel
be sure to read
"Cancellation of Enroll-
ment" on back of page 3.
.8
[୨]
10
2. NUMBER OF EVENT WHICH PERMITS CHANGE. 3. DATE OF EVENT WHICH PERMITS CHANGE.
(See table on back of page 2 for proper number.)
Aug 5, 1978
(DATE)
1.. NAME AND ADDRESS (INCLUDING ZIP CODE). OF EMPLOYING OFFICE
MONTH
DAY
YEAR
WARNING.-Any intentional false statement
in this application or wilful misrepresentation
relative thereto is a violation of the law
punishable by a fine of not more than $10,000.
or imprisonment of not more than 5 years,
or both: (18 U.S.C. 1001.).
2. DATE RECEIVED IN
EMPLOYING OFFICE
3. EFFECTIVE DATE OF
ELECTION
PART F
TO BE
COMPLETED
BY AGENCY
U.S. Rouse
Representatives
Office of Finance, Washington, D.C.
4. PAYROLL OFFICE NO.
5. SF 2811 REPORT NO.
REMARKS
FOR USE ONLY
BY AGENCY.
NW 88326
Docld:322432901 Page 8
(SIGNATURE OF AUTHORIZED AGENCY OFFICIAL)
Page 3.
-
For Official Personnel Folder
Standard Form No. 2809
U.S. Civil Service Commission.
FPM Supplement 890-1
If typewriter is not available, bear down with ball-point pen to make legible copies.
HEALTH BENEFITS REGISTRATION FORM
FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM
(Read instructions on back of page 3.)
TO EMPLOYING OFFICE: SHOW OLD CARRIER'S CONTROL NUMBER ONLY IF ELECTION IS TO CANCEL
ENROLLMENT OR TO CHANGE OPTIONS OR TYPE OF ENROLLMENT IN THE SAME PLAN.
New Carrier's Control No.
22933820
Old Carrier's Control No.
1. NAME
(LAST)
(FIRST)
PART A
ALL WHO REGIS-
TER MUST FILL
IN THIS PART.
4. YOUR MAILING ADDRESS
(NUMBER AND STREET)
NW
(CITY)
(STATE)
(ZIP CODE).
(MIDDLE INITIAL)
2. DATE OF BIRTH
(Use numbers)
MONTH
DAY
YEAR
5. SOCIAL SECURITY
ACCOUNT NUMBER
3. ARE YOU NOW
MARRIED?
Yes
No m
2°
6. SEX
MALE
1
FEMALE
IMPORTANT
ITIS ILLEGAL FOR AN EMPLOYEE OR A MEMBER OF HIS FAMILY TO BE COVERED UNDER MORE THAN ONE ENROLLMENT. IF YOU ARE ALREADY COVERED THROUGH
THE FAMILY ENROLLMENT OF ANOTHER FEDERAL OR DISTRICT OF COLUMBIA EMPLOYEE OR ANNUITANT YOU MUST REGISTER NOT TO ENROLL OR THE OTHER
ENROLLMENT MUST BE CANCELED OR CHANGED TO SELF ONLY. SIMILARLY, IF A FAMILY MEMBER LISTED BY YOU IN PART B IS COVERED THROUGH HIS (OR HER) OWN
ENROLLMENT YOU CANNOT ELECT A FAMILY ENROLLMENT UNLESS THE FAMILY MEMBER CANCELS HIS (OR HER) ENROLLMENT. ALSO SEE BACK OF PAGES 2 AND 3.
PART B
1. I elect to enroll in a health benefits plan, as shown below. I authorize deductions from my salary, compensation, or annuity to cover my
share of the cost of the enrollment. (Copy the information requested below from back page of brochure of the plan you select.)
NAME OF PLAN
ENROLLMENT CODE NUMBER
FILL IN THIS
PART IF YOU
WISH TO ENROLL
OR CHANGE
YOUR ENROLL-
MENT IN A
HEALTH BENE-
FITS PLAN.
If enrollment is
for Self Only,
answer item 1.
If enrollment is
_for Self and
Family, also an-
swer item 2.
OPTION (HIGH OR LOW)
2. In space below list all eligible family members without exception: List your wife or husband first, then your unmarried children under age
22, including (a) legally adopted children and (b) stepchildren, foster children, and illegitimate children who live with you in a regular
parent-child relationship. Include also any unmarried child over 22 who became disabled before age 22 and who, because of the disability,
is incapable of self-support: (Attach a doctor's certificate for a disabled child age 22 or over, if one is not already on file.). DO NOT LIST
PARENTS OR OTHERS WHO ARE NOT ELIGIBLE FAMILY MEMBERS. THEY WILL NOT RECEIVE BENEFITS, EVEN IF THEY
ARE DEPENDENT ON YOU AND ARE LISTED.
Wife or
Husband
NAMES OF FAMILY MEMBERS:
DATE OF BIRTH
(Month, Day, Year)
1
2
NAMES OF FAMILY MEMBERS
DATE OF BIRTH
(Month, Day, Year).
IF YOU ARE
CHANGING YOUR
ENROLLMENT
ALSO FILL IN
PART D.
☐ PART C
3
4
5
Best image possible.
6
7
8
9
10
PLACE AN "X" IN ITEM 1 OR 2 WHICHEVER APPLIES:
1.
FILL IN THIS ✓
ELECT NOT TO ENROLL IN A PLAN UNDER THE FEDERAL
EMPLOYEES HEALTH BENEFITS PROGRAM.
PART IF YOU
WISH NOT TO
ENROLL OR IF
YOU WISH TO
CANCEL YOUR
ENROLLMENT.
PART D
FILL IN THIS
PART, AS WELL
AS PART B, TO
CHANGE YOUR
REGISTRATION.
PART E
ALL WHO REGIS
TER MUST FILL
IN THIS PART.
2. ELECT TO CANCEL MY PRESENT ENROLLMENT UNDER THE
CODE NUMBER SHOWN BELOW:
Present Enrollment Code Number
If you elect to cancel
be sure to read
"Cancellation of Enroll-
ment" on back of page 3.
ANSWER ITEMS 1, 2, AND 3 TO SHOW ENROLLMENT CODE.BEING CHANGED AND ELIGIBILITY FOR CHANGE.
1. ENROLLMENT CODE NUMBER
OF PRESENT PLAN
2
(YOUR SIGNATURE- DO NOT PRINT)
2. NUMBER OF EVENT WHICH PERMITS CHANGE: 3. DATE OF EVENT WHICH PERMITS CHANGE:
(See table on back of page 2 for proper number.)
wis 178
(DATE)
1. NAME AND ADDRESS (INCLUDING ZIP CODE) OF EMPLOYING OFFICE!
NA
MONTH
DAY.
YEAR
WARNING.-Any intentional false statement
in this application or wilful misrepresentation
relative thereto is a violation of the law
punishable by a fine of not more than $10,000
or imprisonment of not more than 5 years,
or both (18 U.S.C. 1001.)
2. DATE: RECEIVED IN
EMPLOYING OFFICE
3. EFFECTIVE DATE OF
ELECTION
PART F
TO BE
COMPLETED
BY AGENCY
REMARKS
FOR USE ONLY
BY AGENCY.
2809-115-01
-NW 88326
Docld:32243290 Page 9
Representat
(SIGNATURE OF AUTHORIZED AGENCY OFFICIAL).
-
Page 4 To Enrollee
4.
PAYROLL OFFICE NO.
5. SF 2811 REPORT NO.
Standard Form No. 2809
U.S. Civil Service Commission
FPM Supplement 890-1
November 1972
PAYROLL INFORMATION FORM AND PERSONNEL AFFIDAVIT
PLEASE USE TYPEWRITER OR PRINT IN INK
CODE:
Finance Office Use Only
Name
U.S. HOUSE OF REPRESENTATIVES
U.S. House
• WENDY SUSAN Employing Office Select Cotitrittee
Collins,
(Last-First-Middle)-
Social Security No. 024-44-5163
Date of birth
ASSASSINATions
03-22-53
(Month Day-Year)
ADDRESSES
3
on
Mailing address for withholding tax statement:"
1630 HubArt St., N.W.
WASHINGTON DC 20009
Mailing address for payroll check (Bank; home, office, etc.):
Select Committee ON ASSASSINAtions
on DC 20009 House Annex #2 RM
FINANCE OFFICE USE ONLY
Bank Code:
&
WASH., D.C
.....
Bank Account No.
20515
(Do not insert Bank Account Number unless check
is to be mailed to a bank) ..
233ADY
PREVIOUS FEDERAL CIVILIAN SERVICE
☐ House of Representatives Office of Select Committee ON ASSASSINAtions
Separation date of last service.
July 31, 78"
Other Federal Departments (including Senate and Architect)
Agency
Separation date of last service
☐ Name (if different from present signature)
While employed as above I was covered by: h
Federal Employees' Health Insurance: ✓ enrolled; ☐ not enrolled; ☐ excluded.
Federal Employees' Life Insurance: ☐ optional; ☐ regular%; ✓ Waived; ☐ excluded.
ELECTION OF RETIREMENT COVERAGE
Coverage under the provisions of the Civil Service Retirement Act is ext
is 
extended to em
employees of the House
of Representatives on a voluntary basis. Once you have elected this coverage and retirement deductions
have been withheld, such deductions cannot be discontinued so long as you are continuously employed
under the Act.
Check the appropriate box to the right:
I elect coverage under the provisions of the Civil Service Retirement Act and request that deduc-
tions begin at the earliest possible date. (If you have had previous Federal or Military service,
please submit dates, Agencies and Military Serial Number on a separate sheet.)
I do not wish to elect coverage under the Retirement Act at this time.
(Note: Legislative employees are not covered by the Social Security Act.)
(Over)
W
(Signature)
NW 88326
Docld:32243290 Page 10
16-82058-1
YES
명
ΝΟ
1

District of Columbia (or State of),
I do solemnly swear (or affirm)-
(1) That
I am a citizen of the United States.;
SS:
if in the service on the date of enactment of the latest General Government Matters
Appropriation Act, and being eligible for citizenship, I had theretofore filed a declara-
tion of intention to become a citizen;
☐
I owe allegiance to the United States;
☐ I am an alien from Poland or the Baltic countries lawfully admitted to the United States
for permanent residence;
☐ I am a citizen of the Republic of the Philippines;
I am a national of a country allied with the United States in the current defense effort;
(2) That my acceptance and holding of office or employment with the U.S. House of Representatives
does not or (if this affidavit is executed by me prior to my acceptance of such office or employment) will
not constitute a violation of the first section of the Act of August 9, 1955 (5 U.S.C. 7311), which reads as
follows:
No person shall accept or hold office or employment in the Government of the United States or any agency thereof,
including wholly owned Government corporations, who-
(1) advocates the overthrow of our constitutional form of government in the United States;
(2) is a member of an organization that advocates the overthrow of our constitutional form of government in the
United States, knowing that such organization so advocates;
(3) participates in any strike or asserts the right to strike against the Government of the United States or such
agency; or
(4) is a member of an organization of Government employees that asserts the right to strike against the Govern-
ment of the United States or such agencies, knowing that such organization asserts such right;
☑' am not
☐ am
(3) That I
receiving a pension, annuity, or retired pay from the United States
Government (if so, please furnish source and claim number);
(Name and location of administering agency)
(Claim number)
(4) That this Payroll Information Form and Personnel Affidavit is complete, true, and correct;.
(5) That I will support and defend the Constitution of the United States against all enemies, foreign
and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely,
without any mental reservation or purpose of evasion; and that I will well and faithfully discharge the
duties of the office on which I am about to enter; So help me God.
Subscribed and sworn to before me this
2104
day of
Julij
NOTARY
SEAL
1978
State-of-
_ Signature of employee)
Public.
- District of Colum
My commission expires
9-15
82
NW 88326
Docld:32243290 Page 11
B.S. GOVERNMENT PRINTING OFFICE
16-82058-1
U.S. House of Representatives
OFFICE OF THE CLERK
OFFICE OF FINANCE
IMPORTANT NOTICE TO EMPLOYEE
Newly employed personnel must execute the attached combined PAYROLL INFORMATION FORM
and PERSONNEL AFFIDAVIT properly and submit them to the Office of Finance, where a Notary Public
is on duty to perform this service without charge. DO NOT SIGN PERSONNEL AFFIDAVIT UNTIL BEFORE
A NOTARY.
Currently employed personnel wishing to make changes in their records need only complete the perti-
ment section of the PAYROLL INFORMATION FORM, indicate their employing office, and affix their signa-
ture. Please be certain that information is legible enough for the Finance Office to identify the individual
making the change.
DETACH AND RETAIN THIS NOTICE
Salary payments are made by check monthly and mailed to the address designated on the Payroll
Information Form. Checks are disbursed from the Office of Finance to normally reach the addressee on the
last working day of each month.
For additional information, contact the Office of Finance, 263 Cannon Office Building, Telephone
Extension 56515 or 57064.
EMPLOYEE BENEFITS
RETIREMENT: An employee of the House of Representatives is eligible to join the Federal Civil
Service Retirement System. Participation is voluntary, and action to elect retirement coverage may be
initiated at any time by completing the appropriate section of the Payroll Information Form. Once an
election is filed and the normal deduction of 7½ percent of the gross salary commences, the employee
cannot discontinue deductions so long as he is continuously employed. (Note: Legislative employees are
not covered by the Social Security Act.)
LIFE INSURANCE: An employee is automatically covered under the Federal Employees' Group
Life Insurance Act unless he waives or subsequently cancels such coverage by filing the required waiver
form with the Office of Finance. The insurance coverage is $10,000; or an amount equal to the gross annual
salary, rounded to the next higher thousand dollars (if the salary is not a multiple of a thousand dollars),
plus an additional two thousand dollars; whichever is the greater. Additional optional insurance coverage
in the amount of $10,000 is also available.
HEALTH BENEFITS: The Federal Employees' Health Benefits Program is available on a voluntary
basis with costs partly financed by the Government. Within 31 days after the effective date of appointment,
every employee must register to enroll in a plan or not to enroll. Future opportunities to enroll or to change
the type of enrollment are shown in the enclosed pamphlet. Also enclosed is the necessary registration form,
Standard Form 2809.
U.S. SAVINGS BONDS: Monthly deductions for bonds in regular bond denominations may be
authorized. Authorization cards are available in the Finance Office.
WORK INJURY BENEFITS: An employee injured or incurring disease as a result of performance
of duty is entitled to medical care and monetary benefits under the provisions of the Federal Employees'
Compensation Act. In instances where such injury or disease is fatal, the employee's family is entitled to
monetary benefits. The Compensation Act is administered by the Bureau of Employees' Compensation,
U.S. Department of Labor. Forms for filing notices of injury and claims for compensation are available
in the Office of Finance or from any Postmaster.
UNEMPLOYMENT COMPENSATION: An employee may under certain circumstances be entitled
to unemployment compensation if discharged or otherwise separated from his employment. The com-
pensation is usually payable by the State (including the District of Columbia) in which the employee had
his last service. However, a claim for benefits may be filed in the local office nearest the employee's
residence. If an employee is discharged for misconduct, quits voluntarily without good cause, or refuses a
suitable job without good cause, then there is a period of disqualification which varies from State to State.
The amount of payments and period of time payable also varies from State to State.
С
16-82058-1
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Docld:32243290 Page 12
MEMORANDUM
TO:
FROM:
DATE:
Thomas Howarth, Budget Officer
Elizabeth Berning, Chief Clerk
I. Charles Mathews, Special Counsel
December 19, 1977
RE:
Ms. Wendy Collins
Please be advised that Ms. Wendy Collins has
accepted the position of Senior Attorney Researcher with
the Select Committee on Assassinations.
Her effective
starting date will be December 29, 1977 and her
starting salary will be $18,000.00.
Your full cooperation will be appreciated in
familiarizing her with staff procedures and welcoming
her aboard.
ICM: jl
NW 88326
Docld:32243290 Page 13
TO:
ALL STAFF
MEMORANDUM
RE: Payroll Certification
The Regulations and Accounting Procedures for Allowances and
Expenses of Committees, Members and Employees of the U.S. House of
Representatives require that, among other things, the Committee's
monthly payroll certification include the relationship, if any, of
each employee to any current Member of Congress. This certification
is signed monthly by our Chairman.
The following are the relationships to be included in the
certification:
father
nephew
brother-in-law
sister-in-law
mother
son
daughter
brother
sister
uncle
aunt
first cousin
niece
husband
stepfather
wife
stepmother
father-in-law
stepbrother
mother-in-law
stepsister
half-brother
half-sister
son-in-law
daughter-in-law
Please complete the appropriate portion below, sign and date
this form, which will then become a part of your permanent personnel
file. If this status changes, you must notify the Committee's Budget
Office immediately of the change.
am not related to any current (95th Congress) Member of Congress.
☐ I am related to a current (95th Congress) Member of Congress.
(Please specify.)
Wendy
NW 88326
Docld:32243290 Page 14
Signature of Employee
29 Dec 77
Date