Human Resources (HR)


Standard Operating Procedures


Retirement Return of Contributions

Original Effective Date:


Revised Effective Date:







  1. Employee must complete an “Application for Retirement Contributions Refund” (Form 5) and have it properly notarized.  Complete instructions and form are available on pages 48-52 of the Retirement Employer Manual.




  1. The employer certification section of Form 5 must be completed by DHHS Payroll only if the member separated employment within the last six months or if terminated.


  1. Send the original Form 5 to the Department of State Treasurer, Retirement Systems Division, 325 North Salisbury Street, Raleigh, North Carolina  27603-1385.