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New Jersey's Temporary Disability Insurance program - get more information, check claim status, or apply for benefits.
New Jersey – Temporary Disability Insurance Application You are responsible for having your healthcare provider and employer complete Parts B & C of this application.
Print an Application. Start here to apply by mail or fax. Printable application forms can be mailed to the address or faxed to the number on on each form. Note: Only applications submitted online will get confirmation of receipt. DOWNLOAD NOW >. Division of Temporary Disability and Family Leave Insurance. Home.
You may be eligible for Temporary Disability Insurance benefits if your physical or mental illness or injury prevents you from working and was not caused by your work. LEARN MORE >.
Temporary Disability Insurance provides cash benefits to employees in New Jersey who are unable to work due to a physical or mental health condition or other disability unrelated to their work, including pregnancy/child birth recovery. Click here to download a printable handout about the program.
5. If you are requesting voluntary Federal Income Tax (F.I.T.) deductions to be withheld from your disability benefits, attach Form W-4S (Request for Federal Income Tax Withholding From Sick Pay) to your claim. Forms should be obtained from your employer or the Internal Revenue Service.
Jul 12, 2024 · If you're unable to apply online, you can download and complete Form DS-1, Claim for Disability Benefits and mail the form to the Division of Temporary Disability Insurance, P.O. Box 387, Trenton, NJ 08625-0327. You can also fax your application to 609-984-4138.
