Assassination Records Review Board
Final Determination Notification
AGENCY :
RECORD NUMBER :
RECORD SERIES :
AGENCY FILE NUMBER :
HSCA
180-10070-10154
STAFF PAYROLL RECORDS
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 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:32244096 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 :
180-10070-10154
:
RECORDS SERIES
STAFF PAYROLL RECORDS
AGENCY FILE NUMBER :
ORIGINATOR : HSCA
FROM:
TO :
TITLE :
DOCUMENT INFORMATION
DATE: 07/11/77
PAGES: 7
SUBJECTS :
HSCA; ADMINISTRATION
SELLECK, ELIZABETH K.
DOCUMENT TYPE : PRINTED FORM
CLASSIFICATION : U
RESTRICTIONS :
CURRENT STATUS : P
DATE OF LAST REVIEW : 07/16/93
OPENING CRITERIA :
Box 3.
COMMENTS :
[R]
-
ITEM IS RESTRICTED
NW 88326
Docld:32244096 Page 2
NW 88326
"U.S. DEPARTMENT OF LABOR
EMPLOYMENT STANDARDS ADMINISTRATION-
Office of Workers' Compensation Programs
December 15, 1978
File No:
.Ms. Elizabeth K. Selleck
4201 Cathedral Avenue
Washington, DC. 20016
Date of Injury:
SSN:
A25-146626
May 25, 1978
531-50-7701
DEPARTM
ENT
UNITED STAT
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 below and on the reverse of
this form. Use a separate sheet of paper numbering the answers
respond with the question numbers.
to cor-
☑ 1. The Federal Employees' Compensation Act requires an injured
employee to give 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 names of any persons who witnessed your injury or
had immediate knowledge of it.
Sincerely
Tom Petty J
John
JOHN PETTY, JR.
Supervisory Claims Examiner
Select Comm. on Assassinations
House of Representatives
HOB #2
Washington, DC. 20515
Docld:32244096 Page 3
Ltr. CA-1011
Include your address, ZIP code, and file number on all correspondence
June 1975
OF LABOR
OF AMERICA
X
40
State the immediate effects of the injury and what you did immedi-
ately thereafter.
.5.
Was any other injury sustained, either on or off duty, between the
date of injury and the date it was first reported to (a) your super-
visor and (b) to a doctor? If so, describe:
✗
6. State the exact reason why you delayed seeking medical attention;
also give 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 of 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
so, describe the prior condition. Give the names and addresses of the
physicians who treated you and the approximate dates you were treated:
X
9.
Did you ever file a claim for workers' compensation benefits from
any source?
If so, give the date and nature of the injury, the name
and address of the office where the claim was filed, and describe
the benefits (if any) which you received:
Χ 10. Arrange for submission of a medical report on the enclosed Form CA-20
from the private physician who examined you as a result of this injury.
NW 88326
Docid:32244096 Page 4
NW 88326
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 Elizabeth K.
Noncontroverted
Select Com. on Assassinations
House of Representatives
HOB #2
Washington, DC. 20515
Controverted
DEPARTME
UNITED STAT
D STATES!
OF LABOR
FAMERICA
We have received Form CA-1 reporting an injury and your agency's response
to the evidence submitted.
It has been determined that:
1. The facts of the injury and employment support the employee's
contention that he/she was a Federal employee who sustained a
traumatic disabling injury in the performance of duty. You
should, therefore, continue his/her pay for the period of dis-
ability not to exceed 45 days.
نه
3.
The information of record is insufficient to make a decision on
the case; however, you should continue the employee's pay without
interruption. Additional information is required as noted on the
reverse of this letter.
Sincere
John
Sincerely
JOHN
Petty Jr
Supervisory claims Examiner
Ms. Elizabeth K. Selleck
4201 Cathedral Avenue
Washington, DC.
20016
Docld:32244096 Page 5
Ltr. CA-1038
Include your address, ZIP code, and file number on all correspondence
Rev. Apr. 1977
C
SELLECK, Elizabeth
Name of Employce
Address
Address
Phone Number
Position Titio
OFFICE OF THE CLERK
U.S. HOUSE OF REPRESENTATIVES.
PERSONAL LEAVE RECORD
1978
YEAR
DALANCE DROUGHT
FORWARD FROM
PRECEDING YEAR
Annual
Leave
Sick
Leave
ANNUAL LEAVE
DATE OF APPOINTMENT
CATEGORY
7-11-77.
1.0
1.5
PRIOR FEDERAL SERVICE
2.0
Years
Months
15
ACCRUED
Position Number:
Level
Step
THIS MONTH
AVAILABLE
THIS MONTH
USED
THIS MONTH
DALANCE
AT CLOSE
OF MONTH
DAY OF MONTH
Annual. Sick Annual
Menth
5
G
7
9
20
11 12 13
14 15 16 17 18 19
20
21 22 23 21 25 26 27
28 29 30
31 Leave Leave
Leave
Sick
Leave
Annual Sick
Annual
Sick
Leave
Leave
Leave
Jon.
Feb.
Mar.
Apr.
་དག
11263
☐ 1
1
Leave
16
0
7
May
June
July
Aug.
Sept.
Oct.
☑☑
☑
☑
XXXX
☑
7-15-78
☐ 1
☐☐
1212 4 12
4/12
1
7
0
8
9
2
10
3
0
12
Dec.
=0.5 day annual leave
= 1.0 day annual leave.
= 0.5 day sick leave
or
= 1.0 day sick leave
= 0.5 day administrative leave
A
or ☑
= 1.0 day administrative leave
= 0.5 day unauthorized absence
10
or
= 1.0 day unauthorized absence
= 0.5. day leave without pay
= 1.0 day leave without pay
NW 88326
Docid:32244096 Page 6
CERTIFIED CORRECT:
Employee's Signature
Dutc
(If employee refuses to sign, state reason below.
Approved:
Chief's Signature
Clerk of the Houso.
Date
Dato
This record will be forwarded to the Clerk of the House at the end of each calendar year, or in case of termination, along
with the request for termination. Upon approval, the record will be filed in the employee's official personnel folder..
EXHIBIT I
EMPLOYEE
INITIALS
7-19-78
Tom:
I need a
form CA-1
(Federal Employee's Notice
of Traumatic Injury) to
file a claim under
Workmen's Compensation
for a cut on my hand
that I suffered on the
for in May. Could you
mail one to me
COMMER
please.
Thanks,
42
CODE: RE: 4/2017 Cathedral
NW #218.W
Bramhington, DC
20016
NW 88326
Docid:32244096 Page 7
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)
Elizabeth K. Selleck
Employee Social Security Number
531-50-7701
Employing Office or Committee/Subcommittee
Assassinations
(Any erasures, corrections, or changes
on this form must be initialed by the
authorizing official.)
Effective Date
7/15/78
Type of Action
☐ Salary Adjustment
☐ Appointment
☐ 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
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. 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_
July 7
73
19.
(Signature of Authorizing Official)
(If appropriate, signature of Subcommittee Chairman or Ranking Minority Member)
LOUIS STOKES, CHAARMAN
(Type or print name of Authorizing Official)
(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.
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)
Copy for Initiating Office or Committee
NW 88326
Docid:32244096 Page 8
PAYROLL AUTHORIZATION FORM
(Please Use Typewriter
for 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
Elizabeth K. Selleck'
7/21/77.
Employee Social Security Number
Type of Action
531 50 7701
☑Appointment
Employing Office or Committee
Salary Adjustment
Termination (At close of business on effective date)
Assassinations
(If type of action is an Appointment or Salary Adjustment, complete the following information.)
Position Title
Staff Investigator
(If Committee Employee, complete appropriate item below.)
1. Standing Committee: Staff-☐ Clerical or ☐ Professional.
2. Special or Select Committee: Authority-H. Res. 465
3.
Joint Committee.
(If Employee of an Officer of the House, complete item below.)
Position Number.
_If applicable, Level_
Gross Annual Salary
$16,000
of 93th Congress. `
Step_
I certify that this authorization is not in violation of 5 U.S.C. 3110(b), prohibiting the employment of--
relatives.
Date
July 11
1977
(Signature of Authorizing Official)
Louin Stokes
(Type or print name of Authorizing Official)
Chaimah
(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:
Office Code.
Monthly Annuity $__.
.00
NW 88326
Docld:32244096 Page 9
APPROVED:
Chairman, Committee on House Administration
Copy for Initiating Office or Committee
FO
7/15
MEMORANDUM
TO:
ALL STAFF
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
niece
brother-in-law
sister-in-law
mother
son
daughter
brother
sister
uncle
aunt
first cousin
husband
wife
father-in-law
mother-in-law
son-in-law
daughter-in-law
stepfather
stepmother
stepbrother
stepsister
half-brother
half-sister
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.
I am not related to any current (95th Congress) Member of Congress.
☐ I am related to a current (95th Congress) Member of Congress.
(Please specify.)
both
Signature of Employee
NW 88326
Docid:32244096 Page 10
7/11/17
Date