STATE EMPLOYEES
RETIREMENT COMMISSION

MEDICAL EXAMINING BOARD
For DISABILITY RETIREMENT
COMPTROLLER'S SEAL STATE OF CONNECTICUT 55 ELM STREET
HARTFORD, CONNECTICUT
06106-1775
Telephone (860) 702-3480
Facsimile (860) 702-3489
STATE OF CONNECTICUT
RETIREMENT SERVICES DIVISION
OFFICE OF THE STATE COMPTROLLER

RETIREMENT SERVICES DIVISION MEMORANDUM 2012-05

April 24, 2012

TO THE HEADS OF ALL STATE AGENCIES

ATTENTION: All Human Resources and Payroll Officers
SUBJECT: SEBAC 2011 - State Employees Retirement System Tier III Refund Application

The purpose of this memorandum is to notify agencies that a new refund application form, CO-628d, "Application for Refund of Retirement Contributions State Employees Retirement System, Tier III Members - Non-vested Only" is now available on the Office of the State Comptroller's website.

Agencies should provide this form to employees at the time they terminate state service provided they are not eligible for a vested retirement benefit from the State Employees Retirement System (SERS) Tier III retirement plan.

An application to "cash out" retirement plan membership for terminated SERS Hybrid Plan members will also be provided in the future.

General instructions for completion are on the form. Any questions concerning this form may be directed to the Retirement Services Division's Data Base Unit by email at osc.databaseunit@po.state.ct.us or by telephone at 860-702-3515.


Very truly yours,

STATE EMPLOYEES RETIREMENT COMMISSION
KEVIN LEMBO, SECRETARY EX OFFICIO

By:

Brenda K. Halpin, Director
Retirement Services Division

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