Retirement Services Division Refund Application Forms
STATE EMPLOYEES
RETIREMENT COMMISSION		 COMPTROLLER'S SEAL STATE OF CONNECTICUT 55 ELM STREET
HARTFORD, CONNECTICUT
06106-1775
TELEPHONE: (860) 702-3480
TELEFAX:(860) 702-3489
MEDICAL EXAMINING BOARD
for DISABILITY RETIREMENT
HEALTH CARE COST
CONTAINMENT COMMITTEE
STATE OF CONNECTICUT
RETIREMENT SERVICES DIVISION
OFFICE OF THE STATE COMPTROLLER

RETIREMENT SERVICES DIVISION MEMORANDUM

April 20, 2009

TO THE HEADS OF ALL STATE AGENCIES

ATTENTION: Human Resources and Payroll Officers
SUBJECT: Retirement Services Division Refund Application Forms

To better serve employees as well as clarify and streamline procedures for both State agency and Retirement Services Division (Division) staff, the Division has reviewed the application for refund process and revised Form CO-628, Application for Refund of Retirement Contributions.

Form CO-628, Application for Refund of Retirement Contributions, has been revised for refunds of terminated State Employees Retirement System (SERS) Tier I members only and terminated members of the Probate Judges and Employees Retirement System. Separate refund application forms have been created for (a) vested SERS Tier II former hazardous duty members wishing to withdraw their hazardous duty contributions prior to their receipt of retirement income, (b) terminated, non vested SERS Tier IIA members and (c) vested Tier I and Tier IIA former hazardous duty members who wish to withdraw that portion of their contributions attributable to their hazardous duty service prior to their receipt of retirement income.

Important retirement and tax information has been added to the forms and the forms are now available on-line in a fillable format as well as through the State's forms ordering process. When using the on-line format, note that the forms must be printed and signed by both the agency and member and notarized before being forwarded to this Division.

A brief explanation of each refund application form follows. Copies of the forms can be found on the internet at http://www.osc.state.ct.us/agencies/forms/.

This application is for State Employees Retirement System (SERS) Tier I members who have terminated state service, are not eligible for an immediate retirement benefit and wish to receive a refund of all their retirement contributions and interest in lieu of their receipt of any future monthly retirement income; Tier I members who meet the age and service requirements for the immediate receipt of monthly retirement income at the time of their termination may not request a refund in lieu of their receipt of monthly retirement benefits.

This application is also designed to be used for terminated Probate Judges & Employees Retirement System members.
This application is for State Employees Retirement System (SERS) Tier II former hazardous duty members who have terminated state service and are not eligible for a retirement benefit under Tier II hazardous duty provisions. Once these contributions are withdrawn the member is no longer eligible for retirement credit under Tier II hazardous duty or disability retirement provisions for service performed as a hazardous duty member. The member may however retain service credit in the non-contributory Tier II retirement plan and, if eligible, should apply for a vested retirement benefit. If such member does not meet the eligibility requirements for a vested retirement benefit, they will not retain retirement credit in Tier II for this service if they return to state employment after experiencing a permanent break in service.
This application is for State Employees Retirement System (SERS) Tier IIA members who have terminated state service and are not eligible for an immediate or a vested retirement benefit; Tier IIA members who are eligible to receive an immediate or a vested benefit at the time of termination may not request a lump sum refund in lieu of their receipt of monthly retirement benefits. However, a vested Tier IIA member who contributed to SERS as a member of the Tier IIA hazardous duty retirement plan may request a refund of the contributions they made in excess of those required for non-hazardous duty Tier IIA service. See Form CO-628c below.
This application is for State Employees Retirement System (SERS) Tier I and Tier IIA members who have terminated state service, contributed as members of the Tier I or Tier IIA hazardous duty retirement plan, are not eligible for retirement under Tier I or Tier IIA hazardous duty provisions, are eligible for a retirement benefit under SERS Tier I or Tier IIA vested rights retirement provisions and wish to withdraw their hazardous duty retirement plan contributions before beginning receipt of a non-hazardous duty, non-disability retirement benefit. Once these contributions are withdrawn the member is no longer eligible for hazardous duty or disability retirement credit for service performed as a hazardous duty member.

Questions regarding the completion of the refund application forms may be addressed to the Division's Data Base Unit by telephone at (860) 702-3517 or by email to osc.databaseunit@po.state.ct.us.

Very truly yours,

STATE EMPLOYEES RETIREMENT COMMISSION
NANCY WYMAN, SECRETARY EX OFFICIO

BY:

Mark E. Ojakian, Deputy Comptroller and Division Director
Retirement Services Division

MEO/JK

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