AGENCY: Department of Health. Human Resource Management and Employee Development

SERIES: 7487
TITLE: Contributions refund application
DATES: 1983-2014.
ARRANGEMENT: None

DESCRIPTION: This is a record submitted by employee leaving state employment to secure a refund of his/her retirement contributions. It includes name, sex, social security number, marital status, date of birth, telephone number, employer, job position information (grade/step, etc.), mailing address, beginning date of employment, date final pay received, whether employee wants taxes deducted from his/her refund, date form completed, signature of the employee, type of retirement system involved, signature of verifying supervisor and date signed, and amount of refund.

RETENTION

DISPOSITION

RETENTION AND DISPOSITION AUTHORIZATION

These records are in Archives' permanent custody.

APPROVED: 01/1986

FORMAT MANAGEMENT

Paper: Retain in Office for 1 year and then destroy.

APPRAISAL

Administrative Fiscal

PRIMARY DESIGNATION

Private