## Page 1

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 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

Released under the John F. Kennedy Assassination Records Collection Act of 1992144 050

2107 Notel. Case#Nt 98326 Dater 2025

NW 88326

Docld:32244096 Page 1

---

## Page 2

Date: 08/20/93

Page: 1

JFK 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 :

PAGES

AGES:97/21/77

SUBJECTS :

HSCA; ADMINISTRATION

SELLECK, ELIZABETH K.

DOCUMENT TYPE : PRINTED FORM

CLASSIFICATION

: U

RESTRICTIONS

CURRENT STATUS

DATE OF LAST REVIEW : 07/16/93

OPENING CRITERIA :

COMMENTS :

BOX

3.

(R] - ITEM IS RESTRICTED

NW 88326

Docld:32244096 Page 2

---

## Page 3

*U.S. DEPARTMENT OF LABOR

EMPLOYMENT STANDARDS ADMINISTRATION.-

Office of Workers' Compensation Programs

December: 15g 1978

File No: A25-146626

Date of Injury: May 25, 1978

SSN: 531-50-7701

• DEI

•Ms. Elizabeth K. Selleck

4201 Cathedral. Avenue

Washingion, DC. 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 below and on the reverse of

this form. Use a separate sheet of paper numbering the answers to cor-

respond with the question

numbers.

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,

If lifting was the cause of injury, describe the object

handled, its weight, what you did with it, etc.).

- 3:

Give the names of any persons who witnessed your injury or

had immediate knowledge of it.

get batty -

Select. Corm. on Assassinations

House of Representatives

HOB #2

Washington, DC. 20515

Include your address, ZIP code, and file number on all correspondence

Ltr. CA-1011

June 1975

NW 88326

Docld:32244096 Page 3

---

## Page 4

Can Way diss

HAt"

P22 ca to in

4:

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:

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:

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.

11.

NW 88326

Docld:32244096 Page 4

---

## Page 5

U.S. DEPARTMENT OF LABOR

EMPLOYMENT STANDARDS ADMINISTRATION

Office of Workers' Compensation Programs

December 15, 1978

Date of In

File No.: A25-146626

Date of Injury: May 25, 1978

Employee: Selleck Elizabeth 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:

1. The facts of the injury and employment support the employee's

contention that he/she was a Federal employee who sustained

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.

2. 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.

3.

The Letty p

Ms. Elizabeth K. Selleck

4201 Cathedral Avenue

Washington, DC. 20016

Include your address, ZIP code, and file number on all correspondence

Ltr. CA-1038

Rev, Apr. 1977

NW 88326

Docld:32244096 Page 5

---

## Page 6

SELLECK, Elizabeth

Name or Employce

Address

Audrass

OFFICE OF THE CLERX

U.S. HOUSE OF REPRESENTATIVES

PERSONAL LEAVE RECORD

1978

YEAR

Phone Number

DATE OF APPOINTMENT

7-11-77

Position Titlo

PRIOR FEDERAL SERVICE

ANNUAL LEAVE

CATEGORY

1.0

1,5

2.0

- Level

Step

ACCRUED

THIS MONTH

DAY OF MONTH

2710 01 12713714713 10 7 18 19 20 21 221

23| 21

25/20 27 29

29 | 30 / 31

Annua!

Leave

Sick

Leave

/

12 1 4

PoshibiT Number

Month

Jon.

Feb.

Mar.

Apr.

May

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

or

or

XXXX

Петтинак

= 0.5 day annual leavo

= 1.0 day annual leave

= 0.5 day sick leave

= 1.0 day sick Icave

=

0.5 day administrative leavo

= 1.0 day administralive leavo

= 0.5 day unauthorized absenco

=

1.0 day unaulhorized absenco

= 0.5. day leave without pay

= 10 doy leave without pay

NW 88326

Docld:32244096 Page 6

AVAILADLE

THIS MONTH

Annual

Leave

2

0

Sick

Leave

USED

THIS MONTX

Annual

Leave

Sick

Leave

BALANCE DROUGHT

FORWARD

PRECEDING

YEAR

Annual

trait

Sick

Leave

5

EXPLOYEE

INITIALS

12

BALANCE

AT

CLOSE

OF MONTH

Annual

Leave

3

Sick

Leave

10

11

12

7=15-78

CERTIFIED CORRECT:

Employço's Signatura

Dutc

111 employee ecluses to sign, state reason below.!

Chiat's Signatura

Date

Approved:

Clerk of the Houso

Dalo

This record will be forwarded to the Clork 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 ollicial personnel folder.

EXHIBITE

---

## Page 7

7-19.78

Tom:

I need a form CA-I

• file a claim andu

Workmen's Compensation

for a cut on my hand

that I suffered on the

job in Me cold you

mail one

Thanks,

liz Seleck

CONSUL KIA

к 12010, 20 7 2182)

serdarshington, De

20016

NW 88326

Docld:32244096 Page 7

---

## Page 8

PAYROLL AUTHORIZATION FORM

(Please Use Typewriter

or Ballpoint Pen)

U.S. HOUSE OF REPRESENTATIVE!

Washington, D.C. 20515

(Any erasures, corrections, or changes

on this form must be initialed by the

authorizing official.)

To the Clerk of the House of Representatives:

I hereby authorize the following payroll action:

Employee Name (First-Middle-Last)

Effective Date

Elizabeth K. Selleck

Employee Social Security Number

7/15/78

Type of Action

531-50-7701

Employing Office or Committee/Subcommittee

Assassinations

• (If type of action is an Appointment, Salary Adjustment, or Title Change, complete appropriate information below.)

Position Title

• Appointment

• Salary Adjustment

• Title Change

i Termination (At close of business on effective date)

I Leave without pay (Beginning with effective date above and ending

close

of business_.

Specity Date

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.)

1.0

Standing Committee: Staff-D Clerical or • Professional.

2. M

Special (Investigative staff of Standing Committee) or Select Committee: Authority-H. Res. 256-of 901 Congress.

3. 0

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

78

., 19--

(if appropriate, signature of Subcommittee Chairman or Ranking Minority Member

(Signature of Authorizing Official)

LOUIS STORES 5

CHAGRINAN

(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:

Office of Finance use only:

Office Code

Monthly Annuity $

Chairman, Committee on House Administration

ID

Benefits

Payroll _

00

as of

Copy for Initiating Office or Committee:

(Revised: August 1, 1977)

NW 88326

Docld:32244096 Page 8

---

## Page 9

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)

Ilisaboth k, Selleck

Employee Social Security Number

531,

50 7791

(Any erasures, corrections, or changes

on this form must be initialed by the

authorizing official.)

Effective Date

7/21/77.

Type of Action

Employing Office or Committee

@ Appointment

• Salary Adjustment

• Termination (At close of business on effective date)

Asgassinations

(If type of action is an Appointment or Salary Adjustment, complete the following information.)

Position Title

Gross Annual Salary

Staid Imactigator

$16,000

(If Committee Employee, complete appropriate item below.)

1. L Standing Committee: Staff -_ Clerical or • Professional.

2. 15 Special or Select Committee: Authority-H. Res.

_of_23thCongress.

3. I 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_

TaLY

., 197)

(Signature of Authorizing Official)

Louds Stokes

(Type or print name of Authorizing Official)

Chaiman

(Title - If Member, District and State)

All appointments and salary adjustménts 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 Housé Administration

Office of Finance use only:

Office Code.

Monthly Annuity S_.

.00

Copy for Initiating Office or Committee

NW 88326

Docld:32244096 Page 9

---

## Page 10

MEMORANDUM

10: 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 Conmittee'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

mother

son

daughter

brother

sister

uncle

aunt

first cousin

nephew

niece

husband

wife

father-in-law

mother-in-law

son-in-law

daughter-in-law

brother-in-law

sister-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

If this status changes, you must notify the Committee's Budget

Ofrice

inmediately 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.)

tube of Employee

141270

NW 88326

Docld:32244096 Page 10

---