DEAR ___________:

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP79-00639A000100100008-4
• Release Decision: RIPPUB
• Original Classification: S
• Document Page Count: 4
• Document Creation Date: November 17, 2016
• Document Release Date: June 16, 2000
• Sequence Number: 8
• Content Type: LETTER

Approved For Relea2000/0 P79-006300100100008-4
Dear
The United States Government, as represented by the Contracting
Officer of this organization, hereby contracts with you, as a contract
employee under the terms and conditions set forth below:
1. New Benefits. By virtue of your employment relationship
under this agreement you are:
(a) Covered under the Civil Service Retirement Act in
conformance with rules and regulations applicable to
appointed employees of this organization. From the
basic compensation paid you hereunder there shall be
deducted the appropriate rate percentage (presently
6-1/2%) for deposit and eventual crediting to the Civil
Service Retirement Fund. Social Security deductions
required by virtue of your cover activities will not be
reimbursed you by this organization.
(b) Covered under the Federal Employees Group Life
Insurance Act in conformance with rules and regulations
applicable to appointed employees of this organization
unless you execute a written waiver of such coverage.
The Government is presently authorized to bear a por-
tion of the premium cost; you will bear the remainder.
(c) Eligible for coverage under the Federal Employees
Health Benefits Act in conformance with rules and
regulations applicable to appointed employees of this
organization. The Government is presently authorized
to bear a portion of the premium cost, you will bear
the remainder. Because of your eligibility under this
Act (whether or not you choose to enroll), your coverage
under the contract employees health program shall cease
thirty-one (31) days after the effective date of this
agreement.
2. Your previous contract with the United States Government,
effective , is herein terminated by mutual
consent of the parties thereto.
3. All provisions of said previous contract not in conflict
with this agreement are incorporated by reference into and made a
part of this agreement.
Approved For Release 2000/08/04: CIA-RDP79-00639A000100100008-4
 Approved For Releasw1000/08 Q4-:cC4E 1 DP79-0063914 00100100008-4
4+. This agreement is effective as of
and shall continue thereafter for
unless sooner terminated as set forth in your previous contract. If
this agreement becomes effective during an overseas assignment
nothing contained herein shall be construed as extending that assign-
ment beyond its originally contemplated duration or invalidating your
entitlement to return travel expensed (if applicable) upon completion
of that assignment.
BY
Contracting Officer
Approved For Release 2000/08/04: CIA-RDP79-00639A000100100008-4
S-E-C-R-E-T
 Approved For ReleasXP2000/08/04: to FDP79-006391600100100008-4
Application for Health Insurance
I hereby apply for health insurance for
( ) self
( ) self and family
Members of my family who are to be covered are:
First Name Date of Birth Relationship
(date
25X1 C
Approved For Release 2000/08/04g-CtA=RDP19-00639A000100100008-4
 . ^ MJ br Rela~s r TE 0I108/04 : CIA-RDP7QOAW40 1Td(T'10000R- SECRET
' ROUTING AND RECORD SHEET
SUBJECT: (Optional)
4 .. :3.
I rt
FROM: EXTENSION NO.
DDP/Publications
GG-04 HQ DATE
2 2 RU61967
TO: (Officer designation, room number, and
buildin
)
DATE
OFFICER'S
COMMENTS (Number each comment to show from whom
g
RECEIVED
FORWARDED
INITIALS
to whom, Draw a line across column after each comment.)
SSA/DDS 7-D-18 HQ
2.
3.
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FORM
3-62
SECRET ^ CONFIDENTIAL ^