An application for State Plan or Family Leave During Unemployment benefits can be ordered or printed from this website or you can contact the Division of Temporary Disability Insurance to obtain an application.

The same application is used to file an Intermittent Family Leave claim. The Intermittent Family Leave Schedule, Part E, must be completed and it must be signed by an authorized employer representative.

Get an Application 

Telephone:  609-292-7060

Mail:  Division of Temporary Disability Insurance
         PO Box 387
         Trenton, NJ  08625-0387

Transitional Claims:

If you are receiving State Plan Temporary Disability benefits for a pregnancy-related disability, instructions for claiming Family Leave Insurance benefits for bonding with your newborn child will automatically be sent to you.

If you have received those instructions for a transitional claim and wish to file your claim, use the link below.

File a Transitional Claim 

Important: 

• Please read all instructions on the claim form and check to be sure that it is filled out completely before submitting your application.
   
• DO NOT submit or file the application until your family leave claim begins.  Filing early can delay your claim.

If you are covered for Family Leave Insurance benefits under a private plan, your employer’s private plan insurance carrier is responsible for processing and paying benefits.  You should obtain a claim form from your employer.  Complete the form and submit it to the private plan carrier for processing.  If you submit your claim to the State, it will be forwarded to the insurance carrier.  This could delay processing of your claim and delay receipt of any benefits due you.