Division of Temporary Disability and Family Leave Insurance (2024)

You can apply for Family Leave Insurance benefitsonline,in the mail, or by fax. Instructions for filing your claim are included in the application. Read all the instructions carefully before completing the application. If filing by mail or fax, don’t forget to sign and date the form.

If planning ahead, you may start your online application up to 60 days in advance. To avoid deletion of your draft application: (1) within 14 days of starting theapplication, provide all information and confirm your claim; then (2) within 14 days after the start of your leave, certify and file your claim. If applying after your leave begins, you have 30 days from your first day of leave to file your application.

We would like to process your claim quickly, but can’t do it without your help.

Keep these tips in mind to avoid delays and receive your benefits faster:

1. Apply online.It’s faster than printing and mailing or faxing your application to us. If you are filing for family caregiving, it also allows your family member'smedical provider to easily complete their section online once they get the required instructions from you. Remember, it is your responsibility to give these instructions to the medical provider to complete – they are not automatically notified by our system. If you do apply online, don’t also submit that claim by mail or fax. That may delay the processing of you’re application.
2. Fill out your application completely and accurately. Read all instructions first. If you’re not sure how to answer a question, check out our FAQ orForm Look Up for more information. If you still need help, contact us.
3. Include your Social Security number on all correspondence.
4. Don’t fax us pictures of documents. If you want to submit a digital copy of a document, use a free mobile app like Adobe Scan orDropbox to transform a mobile phone picture into a high-contrast, black-and-white PDF file you can print and fax.
5. Get ready to receive your payments. Money Network/My Banking Direct will mail your prepaid debit card in a plain envelope (which might even look like junk mail), so check all your mail carefully. If you already have a debit card from a previous Temporary Disability, Family Leave, or Unemployment Insurance claim, we will use that same card to pay benefits for new claims. If you can’t find your card,contact Money Network/My Banking Direct for a replacement.

New Jersey workers are encouraged to apply.
In order to have a valid claim forFamily Leave Insurance, you need to have paid into the program through your employment and meet minimum gross earnings requirements.Family Leave Insurance is available to most New Jersey workers.

Exemptions include:

• federal government employees
• out-of-state employees
• faith-based organizations
• workers that are not technically employees (such as contractors).

If your employer is covered forFamily Leave Insurance, they are required to set up payroll contributions for you. If you believeyou are covered under the program but payroll contributions have not been made, you are still encouraged to apply as it may have been an error. If you became unemployed recently and have a need forFamily Leave Insurance, you still may be eligible for benefits and we encourage you to apply. In that case, we will forward your application to our Family Leave During Unemploymentsection.

Your employer is required to report your wages to the state after each calendar quarter. When your claim is under review, we consider the earnings reported for the 5 completed quarters prior to the week your leave began. The first 4 quarters of that time frame iscalled the base year.

To qualify for Family Leave Insurance in 2023, you must have worked 20 weeks earning at least $260 weekly, or have earned a combined total of $13,000 in those four quarters (the base year).

To qualify for Family Leave Insurance in 2024, you must have worked 20 weeks earning at least $283 weekly, or have earned a combined total of $14,200 in those four quarters (the base year).

Yourregular base year periodconsists of 52 weeks and is determined by the date you apply for Family Leave Insurance benefits, as outlined in the chart below:

The wages earned during your base year will determine the amount of weekly benefits you may receive, and the total amount you can claim in a given year.

For workers who don't qualify with a standard base year, we have other ways of calculating a base year.Click here for more information on these alternate base years.

1. First, wecalculate your average weekly wage. We do this by dividing your base year earnings by the number of base weeks.
In 2023, a "base week" is any week you earn $260 or more.
In 2024, a "base week" is any week you earn $283 or more.

2. Now, wecan determine your weekly benefit rate.Claimants are paid 85% of their average weekly wage, up to the maximum weekly benefit rate set for that calendar year.
In 2023, the maximum weekly benefit rate is $1,025 per week.
In 2024, the maximum weekly benefit rate is $1,055 per week.

For example, let’s say Steve's first day of family leave is Friday, March 1, 2024. To see how much he would receive weekly on Family Leave Insurance, we look at his reported wages for the first four of the last five completed quarters:

Quarters 1 through 4 are the regular base year and the timeframe used to calculate his benefits.

Total base year earnings:$18,200 which we divide by 45 (the number of base weeks)

This gives us anaverage weekly wageof $404.

Steve’s weekly benefit rate is 85% of his average weekly wage:$343

If Steve is taking his leave on a day by day basis, he will receive 1/7 of his weekly benefit rate for each day he claims.

Family Leave Insurance benefits do not need to be claimed all at once. You can claim Family Leave Insurance benefits in oneconsecutive 12-week period, or on a day-by-day basis to suit your needs. However, the manner in which you choose to claim your leave will determine the duration of leave that you are entitled to.

Continuous Leave: You may receive up to 12 weeks of benefits in a 12-month period, if the benefits are claimed for one continuous period of unpaid leave.

Non-Continuous (intermittent) Leave:If you are claiming benefits on an intermittent schedule,whether it be a week, a month, or a day at a time,you may receive up to 56 individual days (8 weeks) of Family Leave benefits in a 12-month period. If you take your leave in a non-continuous manner, let us know those datesaftertaking each segment. If you are approved for Family Leave Insurance benefits but do not initially claim your maximum duration of leave when filing, we will mail you aContinued Claim Certification (FL3), which includes a schedule that you must fill out and sign – showing the days youdid not workduring the period. You will need to submit an updated schedule after each period of leave is completed.

You mustgive your employer 30 days’ noticeif taking your family leave bonding in one continuous period, and 15 days' notice if taking your leave in a non-continuous manner. If you plan to care for a family member and take your leave all at once, you mustgive your employer reasonable notice, unless there are unforeseen or emergency circ*mstances and 15 days' notice for separate periods of leave.

If you do not give your employer adequate notice, your benefit entitlement may be reduced by 14 days.We encourage you tokeep your employer informed. Having an open discussion with your employer about your need for leave will allow them to prepare for your absence and make adjustments to work schedules if necessary. Your employer may also be able to provide insight on job protection and if you qualify for it through the federalFamily and Medical Leave Act (FMLA)or theNew Jersey Family Leave Act (NJFLA).

Applications are processed in the order they are received. Payment of benefits will be delayed if your application is incomplete or contains missing or conflicting information.

Benefits are issued on adebit card sent to you directly by Money Network/My Banking Direct. You will receive this card in the mail in a plain, unmarked envelope once your claim is approved. Don’t lose it!

For Continuous Leave: Payments are usually issued every two weeks after the initial payment, with a one-week lag for processing time.Payment may be more or less than a one-week period.
For Non-Continuous Leave:Each day of benefits paid to you is one-seventh (1/7) of your weekly benefit rate.

Once a payment is posted, funds should be available on your debit card within three business days of the payment date. No federal income tax is withheld from your benefits unless you request a 10 percent deduction when you apply.

Family Leave benefits are paid until you: return to work, exhaust your maximum benefit entitlement, your child's first birthday, 12 months after adoptive or foster placement, or your family member no longer needs care.

Here is a list of the important mail you’ll receive from us, in the order it’s typically sent:

1. C05 - Confirmation of Claim Receipt: This form lets you know we received your claim. Don’t discard it! You’ll need it if you have to update any of your information (name, address, earlier return to work date, etc.).
2. D10 - Eligible Notice: This form tells you that your claim has been approved for benefits.
3. D30 - Ineligible Notice: This form tells you that your claim has not been approved for benefits.
4. FL3 - Request to Claimant for Continued Claim Information: If your family caregiving or bonding claim is approved and you did not initially request your maximum benefit duration, you’ll receive this form so you can extend your benefits.

You also may receive one or more of the following if your application contains missing or conflicting information:

1. C10 - Request to Claimant for Information: You’ll receive this form if your claim has missing or conflicting information.
2. M10 - Request for Medical Information: You’ll receive this form if your caregiving claim is missing medical information, if the medical information needs further review, or if your statement conflicts with the medical provider’s statement.

For more information about specific forms or notices, see our Form Look Up page.

The family leave program is financed 100% by worker payroll deductions. Employers do not contribute to the program.

For 2023, workers contribute 0.06% on the first $156,800 (wage cap) in covered wages earned during this calendar year. The maximum worker contribution for 2023 is $94.08. This contribution is in the form of a salary deduction that your employer takes from your weekly wages.

For 2024, workers contribute 0.09% on the first $161,400 (wage cap) in covered wages earned during this calendar year. The maximum worker contribution for 2024 is $145.26. This contribution is in the form of a salary deduction that your employer takes from your weekly wages.

If you have not claimed your maximum benefit amount, you may reestablish a claim within the same 12-month period to care for a different family member, or during or following employment with a different employer.

After the 12-month period, regardless of whether or not you used the maximum amount of benefits, you must submit a completely new application for Family Leave Insurance benefits.

New parents do not need to claim their benefits all at once. You can claim Family Leave Insurance to bond in oneconsecutive 12-week period, or on a day-by-day basis to suit your needs. However, the manner in which you choose to claim your leave will determine the duration of leave that you are entitled to.

Continuous Leave: You may receive up to 12 weeks of benefits before your child’s first birthday, if the benefits are claimed for one continuous period of unpaid leave.

Non-Continuous (intermittent) Leave:If you are claiming benefits on an intermittent schedule,whether it be a week, a month, or a day at a time, you may receive up to 56 individual days (8 weeks) of Family Leave benefits before your child’s first birthday. If you take your leave in a non-continuous manner, let us know those dates after taking each segment. If you are approved for Family Leave Insurance benefits but do not initially claim your maximum duration of leave when filing, we will mail you a Continued Claim Certification (FL3), which includes a schedule that you must fill out and sign – showing the days you did not work during the period. You will need to submit an updated schedule after each period of leave is completed.

You can apply for Family Leave Insurance benefitsonline,in the mail, or by fax. Instructions for filing your claim are included in the application. Read all the instructions carefully before completing the application. If filing by mail or fax, don’t forget to sign and date the form.

It isyourresponsibility to have the information submitted to us online, by mail, or by fax.

This is the information we need from you to complete your application:

• Your Social Security number, contact information, and date of birth
• The date your bonding leave begins
• Dates you worked for any employers in the last 18 months, the employers’ contact information, and the address(es) where you worked
• Dates of any paid time off or other benefits you received after the last day you worked

When you complete your part online, you will get a confirmation page showing your part is complete. If any information is missing or conflicting, you will be prompted to print out (or save as a PDF file) the applicable forms to complete and return to the division. If you do not have access to a printer when initially filing your application, you have a fourteen day window to return and print the instructions when a printer is available. You can do so by clicking Access claim documentsat the top of this page.

If planning ahead, you may start your online application up to 60 days in advance. To avoid deletion of your draft application: (1) within 14 days of starting theapplication, provide all information and confirm your claim; then (2) within 14 days after the start of your leave, certify and file your claim. If applying after your leave begins, you have 30 days from your first day of leave to file your application.

We would like to process your claim quickly, but can’t do it without your help.

Keep these tips in mind to avoid delays and receive your benefits faster:

1. Apply online.It’s faster than printing and mailing or faxing your application to us. If you do apply online, don’talsosubmit that claim by mail or fax. That may delay the processing of you’re application.
2. Fill out your application completely and accurately. Read all instructions first. If you’re not sure how to answer a question, check out ourFAQorForm Look Upfor more information. If you still need help,contact us.
3. Include your Social Security numberon all correspondence.
4. Don’t fax us pictures of documents.If you want to submit a digital copy of a document, use a free mobile app like Adobe ScanorDropboxto transform a mobile phone picture into a high-contrast, black-and-white PDF file you can print and fax.
5. Get ready to receive your payments.Money Network/My Banking Direct will mail your prepaid debit card in a plain envelope (which might even look like junk mail), so check allyour mail carefully. If you already have a debit card from a previous Temporary Disability, Family Leave, or Unemployment Insurance claim, we will use that same card to pay benefits for new claims. If you can’t find your card,contact Money Network/My Banking Directfor a replacement.

New Jersey workers are encouraged to apply.
In order to have a valid claim forFamily LeaveInsurance, you need to have paid into the program through your employment and meet minimum gross earnings requirements.Family LeaveInsurance is available to most New Jersey workers.

Exemptions include:

• federal government employees
• out-of-state employees
• faith-based organizations
• workers that are not technically employees (such as contractors).

If your employer is covered forFamily LeaveInsurance, they are required to set up payroll contributions for you. If you believeyou are covered under the program but payroll contributions have not been made, you are still encouraged to apply as it may have been an error. If you became unemployed recently and have a need forFamily LeaveInsurance, you still may be eligible for benefits and we encourage you to apply. In that case, we will forward your application toourFamily Leave During Unemploymentsection.

Your employer is required to report your wages to the state after each calendar quarter. When your claim is under review, we consider the earnings reported for the 5 completed quarters prior to the week your leave began. The first 4 quarters of that time frame iscalled thebase year.

To qualify for Family Leave Insurance in 2023, you must have worked 20 weeks earning at least $260 weekly, or have earned a combined total of $13,000 in those four quarters (the base year).To qualify for Family Leave Insurance in 2024, you must have worked 20 weeks earning at least $283 weekly, or have earned a combined total of $14,200 in those four quarters (the base year).

Yourregular base year periodconsists of 52 weeks and is determined by the date you apply forFamily Leave Insurance benefits, as outlined in the chart below:

The wages earned during your base year will determine the amount of weekly benefits you may receive, and the total amount you can claim in a given year.

For workers who don't qualify with a standard base year, we have other ways of calculating a base year.Click herefor more information on these alternate base years.

1. First, wecalculate your average weekly wage. We do this by dividing your base year earningsby the number of base weeks.

In 2023, a "base week" was any week you earned $260 or more. In 2024, a "base week" is any week you earn $283 or more.

2. Now, wecan determine your weekly benefit rate.Claimants are paid 85% of their average weekly wage, up to the maximum weekly benefit rate set for that calendar year.

In 2023, the maximum weekly benefit rate is $1,025 per week.

In 2024, the maximum weekly benefit rate is $1,055 per week.

For example, let’s say Steve's first day of family leave is Friday, March 1, 2024. To see how much he would receive weekly on Family Leave Insurance, we look at his reported wages for the first four of the last five completed quarters:

Quarters 1 through 4 are the regular base year and the timeframe used to calculate his benefits.

Total base year earnings:$18,200 which we divide by 45 (the number of base weeks)

This gives us anaverage weekly wageof $404.

Steve’s weekly benefit rate is 85% of his average weekly wage:$343.

If Steve is taking his leave on a day by day basis, he will receive 1/7 of his weekly benefit rate for each day he claims.

Applications are processed in the order they are received. Payment of benefits will be delayed if your application is incomplete or contains missing or conflicting information.

Benefits are issued on adebit card sent to you directly by Money Network/My Banking Direct. You will receive this card in the mail in a plain, unmarked envelope once your claim is approved. Don’t lose it!

For Continuous Leave:Payments are usually issued every two weeks after the initial payment, with a one-week lag for processing time.Payment may be more or less than a one-week period.
For Non-Continuous Leave:Each day of benefits paid to you is one-seventh (1/7) of your weekly benefit rate.

Once a payment is posted, funds should be available on your debit card within three business days of the payment date. No federal income tax is withheld from your benefits unless you request a 10 percent deduction when you apply.

Family Leave benefits are paid until: you return to work, exhaust your maximum benefit entitlement, or your child's first birthday.

If you are claiming Family Leave benefits in one continuous period, you mustgive your employer 30 days’ noticebefore startingyour leave. If you are bonding in separate periods of leave, you must give your employer 15 days' notice before each period of leave.

If you do not give your employer adequate notice, your benefit entitlement may be reduced by 14 days.We encourage you tokeep your employer informed. Having an open discussion with your employer about your need for leave will allow them to prepare for your absence and make adjustments to work schedules, if necessary. Your employer may also be able to provide insight on job protection and if you qualify for it through the federalFamily and Medical Leave Act (FMLA)or theNew Jersey Family Leave Act (NJFLA).

Here is a list of the important mail you’ll receive from us, in the order it’s typically sent:

1. C05-Confirmation of Claim Receipt: This form lets you know we received your claim. Don’t discard it! You’ll need it if you have to update any of your information (name, address, earlier return to work date, etc.).
2. D10-Eligible Notice: This form tells you that your claim has been approved for benefits.
3. D30-Ineligible Notice: This form tells you that your claim hasnotbeen approved for benefits.
4. FL3-Request to Claimant for Continued Claim Information: If your newborn bonding claim is approved, and you did not initially request your maximum benefit duration, you’ll receive this form so you can claim additional days of benefits.

If your application contains missing or conflicting information, you may recieve aC10-Request to Claimant for Information.Be sure to complete and return this form to the division promptly to ensure your application is approved.

For more information about specific forms or notices, see ourForm Look Up page.

The family leave program is financed 100% by worker payroll deductions. Employers do not contribute to the program.

For 2023, workers contribute 0.06% on the first $156,800 (wage cap) in covered wages earned during this calendar year. The maximum worker contribution for 2023 is $94.08. This contribution is in the form of a salary deduction that your employer takes from your weekly wages.

For 2024, workers contribute 0.09% on the first $161,400 (wage cap) in covered wages earned during this calendar year. The maximum worker contribution for 2024 is $145.26. This contribution is in the form of a salary deduction that your employer takes from your weekly wages.

Workers can receive benefits for twelve consecutive weeks (84 days) or up to eight weeks (56 days) of intermittent leave in a 12-month period.

The 12-monthperiod begins on the date ofyour child's birth. If you have not claimed your maximum benefit amount, you may reestablish a claim within the same 12-month period to care for a family member, or during or following employment with a different employer.

If you received Temporary Disability Insurance benefits from the state while you recovered from delivery, you will receive aform in the mail (FL2) with instructions on how toapply online for Family Leave Insurance benefits to bond with your newborn. The bonding period can begin after your doctor certifies that you have medically recovered from the birth.

If you haven’t received Temporary Disability Insurance benefits from the state, you can apply for Family Leave Insurance with apaper application (FL-1) oronline during your baby’s first year.

New Jersey workers are encouraged to apply.
In order to have a valid claim forFamily LeaveInsurance, you need to have paid into the program through your employment and meet minimum gross earnings requirements.Family LeaveInsurance is available to most New Jersey workers.

Exemptions include:

• federal government employees
• out-of-state employees
• faith-based organizations
• workers that are not technically employees (such as contractors).

If your employer is covered forFamily LeaveInsurance, they are required to set up payroll contributions for you. If you believeyou are covered under the program but payroll contributions have not been made, you are still encouraged to apply as it may have been an error. If you became unemployed recently and have a need forFamily LeaveInsurance, you still may be eligible for benefits and we encourage you to apply. In that case, we will forward your application toourFamily Leave During Unemploymentsection.

Mothers who collected state Temporary Disability Insurance for their pregnancy and immediately transition into Family Leave bonding, have already met the minimum earnings requirement. See ourmaternity leave page for more information.

All other claims
Your employer is required to report your wages to the state after each calendar quarter. When your claim is under review, we consider the earnings reported for the 5 completed quarters prior to the week your leave began. The first 4 quarters of that time frame iscalled thebase year.

To qualify for Family Leave Insurance in 2023, you must have worked 20 weeks earning at least $260 weekly, or have earned a combined total of $13,000 in those four quarters (the base year).

To qualify for Family Leave Insurance in 2024, you must have worked 20 weeks earning at least $283 weekly, or have earned a combined total of $14,200 in those four quarters (the base year).

Yourregular base year periodconsists of 52 weeks and is determined by the date you apply forFamily Leave Insurance benefits, as outlined in the chart below:

The wages earned during your base year will determine the amount of weekly benefits you may receive, and the total amount you can claim in a given year.

For workers who don't qualify with a standard base year, we have other ways of calculating a base year.Click herefor more information on these alternate base years.

1. First, wecalculate your average weekly wage. We do this by dividing your base year earningsby the number of base weeks.
In 2023, a "base week" was any week you earned $260 or more.
In 2024, a "base week" is any week you earn $283 or more.

2. Now, wecan determine your weekly benefit rate.Claimants are paid 85% of their average weekly wage, up to the maximum weekly benefit rate set for that calendar year.
In 2023, the maximum weekly benefit rate is $1,025 per week.
In 2024, the maximum weekly benefit rate is $1,055 per week.

For example, let’s say Steve's first day of family leave is Friday, March 1, 2024. To see how much he would receive weekly on Family Leave Insurance, we look at his reported wages for the first four of the last five completed quarters:

Quarters 1 through 4 are the regular base year and the timeframe used to calculate his benefits.

Total base year earnings:$18,200 which we divide by 45 (the number of base weeks)

This gives us anaverage weekly wageof $404.

Steve’s weekly benefit rate is 85% of his average weekly wage:$343

If Steve is taking his leave on a day by day basis, he will receive 1/7 of his weekly benefit rate for each day he claims.

Applications are processed in the order they are received. Payment of benefits will be delayed if your application is incomplete or contains missing or conflicting information.

Benefits are issued on adebit cardsent to you directly by Money Network/My Banking Direct. You will receive this card in the mail in a plain, unmarked envelope once your claim is approved.Don’t lose it!

For Continuous Leave:Payments are usually issued every two weeks after the initial payment, with a one-week lag for processing time.Payment may be more or less than a one-week period.
For Non-Continuous Leave: Each day of benefits paid to you is one-seventh (1/7) of your weekly benefit rate.

Once a payment is posted, funds should be available on your debit card within three business days of the payment date. No federal income tax is withheld from your benefits unless you request a 10 percent deduction when you apply.

Family Leave benefits are paid until: you return to work, exhaust your maximum benefit entitlement, or your child's first birthday.

New moms do not need to take their leave all at once. You can claim Family Leave Insurance to bond in oneconsecutive 12-week period, or on a day-by-day basis to suit your needs. However, the manner in which you choose to claim your leave will determine the duration of leave that you are entitled to.

Continuous Leave: You may receive up to 12 weeks of benefits before your child’s first birthday, if the benefits are claimed for one continuous period of unpaid leave.

Non-Continuous (intermittent) Leave:If you are claiming benefits on an intermittent schedule,whether it be a week, a month, or a day at a time,you may receive up to 56 individual days (8 weeks) of Family Leave benefits before your child’s first birthday. If you take your leave in a non-continuous manner, let us know those datesaftertaking each segment. If you are approved for Family Leave Insurance benefits but do not initially claim your maximum duration of leave when filing, we will mail you aContinued Claim Certification (FL3), which includes a schedule that you must fill out and sign – showing the days youdid not workduring the period. You will need to submit an updated schedule after each period of leave is completed.

To receive Family Leave benefits in one continuous period, you must notify your employer 30 days’ in advance of the date you plan to start your leave. To claim your benefits in non-consecutive days, you must notify your employer 15 days’ in advance of each anticipated absence.

If you do not give your employer adequate notice, your benefit entitlement may be reduced by 14 days. We encourage you tokeep your employer informed. Having an open discussion with your employer about your need for leave will allow them to prepare for your absence and make adjustments to work schedules if necessary. Your employer may also be able to provide insight on job protection and if you qualify for it through the federalFamily and Medical Leave Act (FMLA)or theNew Jersey Family Leave Act (NJFLA).

The family leave program is financed 100% by worker payroll deductions. Employers do not contribute to the program.

For 2023, workers contribute 0.06% on the first $156,800 (wage cap) in covered wages earned during this calendar year. The maximum worker contribution for 2023 is $94.08. This contribution is in the form of a salary deduction that your employer takes from your weekly wages.

For 2024, workers contribute 0.09% on the first $161,400 (wage cap) in covered wages earned during this calendar year. The maximum worker contribution for 2024 is $145.26. This contribution is in the form of a salary deduction that your employer takes from your weekly wages.

Adoptive and Foster parents do not need to take their leave all at once. You can claim Family Leave Insurance to bond in oneconsecutive 12-week period, or on a day-by-day basis to suit your needs. However, the manner in which you choose to claim your leave will determine the duration of leave that you are entitled to.

Continuous Leave: You may receive up to 12 weeks of benefits within a year of the child's adoption or placement, if the benefits are claimed for one continuous period of unpaid leave.

Non-Continuous (intermittent) Leave:If you are claiming benefits on an intermittent schedule,whether it be a week before returning to work or a day at a time,you may receive up to 56 individual days (8 weeks) of Family Leave benefits within a year of the child's adoption or placement. If you take your leave in a non-continuous manner, let us know those datesaftertaking each segment. If you are approved for Family Leave Insurance benefits but do not initially claim your maximum duration of leave when filing, we will mail you aContinued Claim Certification (FL3), which includes a schedule that you must fill out and sign – showing the days youdid not workduring the period. You will need to submit an updated schedule after each period of leave is completed.

You can apply for Family Leave Insurance benefitsonline,in the mail, or by fax.Instructions for filing your claim are included in the application. Read all the instructions carefully before completing the application. If filing by mail or fax, don’t forget to sign and date the form.

It isyourresponsibility to havethe information submitted to us online, by mail, or by fax.

This is the information we need from you to complete your application:

• Your Social Security number, contact information, and date of birth
• The date your bonding leave begins
• Dates you worked for any employers in the last 18 months, the employers’ contact information, and the address(es) where you worked
• Dates of any paid time off or other benefits you received after the last day you worked

When you complete your part online, you will get a confirmation page showing your part is complete. If any information is missing or conflicting, you will be prompted to print out (or save as a PDF file) the applicable forms to complete and return to the division. If you do not have access to a printer wheninitially filing your application, you have a fourteen day window to return andprint the instructionswhen a printer is available. You can doso by clickingAccess claim documentsat the top of this page.

If planning ahead, you may start your online application up to 60 days in advance. To avoid deletion of your draft application: (1) within 14 days of starting theapplication, provide all information and confirm your claim; then (2) within 14 days after the start of your leave, certify and file your claim. If applying after your leave begins, you have 30 days from your first day of leave to file your application.

We would like to process your claim quickly, but can’t do it without your help.

Keep these tips in mind to avoid delays and receive your benefits faster:

1. Apply online.It’s faster than printing and mailing or faxing your application to us.If you do apply online, don’talsosubmit that claim by mail or fax. That may delay the processing of you’re application.
2. Fill out your application completely and accurately. Read all instructions first. If you’re not sure how to answer a question, check out ourFAQorForm Look Upfor more information. If you still need help,contact us.
3. Include your Social Security numberon all correspondence.
4. Don’t fax us pictures of documents.If you want to submit a digital copy of a document (such as a birth certificate), use a free mobile app likeAdobe ScanorDropboxto transform a mobile phone picture into a high-contrast, black-and-white PDF file you can print and fax.
5. Get ready to receive your payments.Money Network/My Banking Direct will mail your prepaid debit card in a plain envelope (which might even look like junk mail), so check allyour mail carefully. If you already have a debit card from a previous Temporary Disability, Family Leave, or Unemployment Insurance claim, we will use that same card to pay benefits for new claims. If you can’t find your card,contact Money Network/My Banking Directfor a replacement.

New Jersey workers are encouraged to apply.
In order to have a valid claim forFamily LeaveInsurance, you need to have paid into the program through your employment and meet minimum gross earnings requirements.Family LeaveInsurance is available to most New Jersey workers.

Exemptions include:

• federal government employees
• out-of-state employees
• faith-based organizations
• workers that are not technically employees (such as contractors).

If your employer is covered forFamily LeaveInsurance, they are required to set up payroll contributions for you. If you believeyou are covered under the program but payroll contributions have not been made, you are still encouraged to apply as it may have been an error. If you became unemployed recently and have a need forFamily LeaveInsurance, you still may be eligible for benefits and we encourage you to apply. In that case, we will forward your application toourFamily Leave During Unemploymentsection.

Your employer is required to report your wages to the state after each calendar quarter. When your claim is under review, we consider the earnings reported for the 5 completed quarters prior to the week your leave began. The first 4 quarters of that time frame iscalled thebase year.

To qualify for Family Leave Insurance in 2023, you must have worked 20 weeks earning at least $260 weekly, or have earned a combined total of $13,000 in those four quarters (the base year).

To qualify for Family Leave Insurance in 2024, you must have worked 20 weeks earning at least $283 weekly, or have earned a combined total of $14,200 in those four quarters (the base year).

Yourregular base year periodconsists of 52 weeks and is determined by the date you apply for Family Leave Insurance benefits, as outlined in the chart below:

The wages earned during your base year will determine the amount of weekly benefits you may receive, and the total amount you can claim in a given year.

For workers who don't qualify with a standard base year, we have other ways of calculating a base year.Click herefor more information on these alternate base years.

1. First, wecalculate your average weekly wage. We do this by dividing your base year earningsby the number of base weeks.
In 2023, a "base week" was any week you earned $260 or more.
In 2024, a "base week" is any week you earn $283 or more.

2. Now, wecan determine your weekly benefit rate.Claimants are paid 85% of their average weekly wage, up to the maximum weekly benefit rate set for that calendar year.
In 2023, the maximum weekly benefit rate is $1,025 per week.
In 2024, the maximum weekly benefit rate is $1,055 per week.

For example, let’s say Steve's first day of family leave is Friday, March 1, 2024. To see how much he would receive weekly on Family Leave Insurance, we look at his reported wages for the first four of the last five completed quarters:

Quarters 1 through 4 are the regular base year and the timeframe used to calculate his benefits.

Total base year earnings:$18,200 which we divide by 45 (the number of base weeks)

This gives us anaverage weekly wageof $404.

Steve’s weekly benefit rate is 85% of his average weekly wage:$343

If Steve is taking his leave on a day by day basis, he will receive 1/7 of his weekly benefit rate for each day he claims.

Applications are processed in the order they are received. Payment of benefits will be delayed if your application is incomplete or contains missing or conflicting information.

Benefits are issued on adebit card sent to you directly by Money Network/My Banking Direct. You will receive this card in the mail in a plain, unmarked envelope once your claim is approved. Don’t lose it!

For Continuous Leave:Payments are usually issued every two weeks after the initial payment, with a one-week lag for processing time.Payment may be more or less than a one-week period.
For Non-Continuous Leave:Each day of benefits paid to you is one-seventh (1/7) of your weekly benefit rate.

Once a payment is posted, funds should be available on your debit card within three business days of the payment date. No federal income tax is withheld from your benefits unless you request a 10 percent deduction when you apply.

Family Leave benefits are paid until you: return to work, exhaust your maximum benefit entitlement, or 12 months after the child's placement has passed.

The family leave program is financed 100% by worker payroll deductions. Employers do not contribute to the program.

For 2023, workers contribute 0.06% on the first $156,800 (wage cap) in covered wages earned during this calendar year. The maximum worker contribution for 2023 is $94.08. This contribution is in the form of a salary deduction that your employer takes from your weekly wages.

For 2024, workers contribute 0.09% on the first $161,400 (wage cap) in covered wages earned during this calendar year. The maximum worker contribution for 2024 is $145.26. This contribution is in the form of a salary deduction that your employer takes from your weekly wages.

If you are claiming Family Leave benefits in one continuous period, you mustgive your employer 30 days’ noticebefore startingyour leave. If you are bonding in separate periods of leave, you must give your employer 15 days' notice before each period of leave.

If you do not give your employer adequate notice, your benefit entitlement may be reduced by 14 days.We encourage you tokeep your employer informed. Having an open discussion with your employer about your need for leave will allow them to prepare for your absence and make adjustments to work schedules, if necessary. Your employer may also be able to provide insight on job protection and if you qualify for it through the federalFamily and Medical Leave Act (FMLA)or theNew Jersey Family Leave Act (NJFLA).

Here is a list of the important mail you’ll receive from us, in the order it’s typically sent:

1. C05-Confirmation of Claim Receipt: This form lets you know we received your claim. Don’t discard it! You’ll need it if you have to update any of your information (name, address, earlier return to work date, etc.).
2. D10-Eligible Notice: This form tells you that your claim has been approved for benefits.
3. D30-Ineligible Notice: This form tells you that your claim hasnotbeen approved for benefits.
4. FL3-Request to Claimant for Continued Claim Information: If your bonding claim is approved and you did not initially request your maximum benefit duration,you’ll receive this form so you can extend your benefits.

If your application contains missing or conflicting information, you may recieve aC10-Request to Claimant for Information.Be sure to complete and return this form to the division promptly to ensure your application is approved.

For more information about specific forms or notices, see ourForm Look Up page.

Workers can receive benefits for up to twelve consecutive weeks (84 days) or up to eight weeks (56 days) of intermittent leave in a 12-month period.

The 12-month period begins on the first dayof the child's placement or adoption.

If you have not claimed your maximum benefit amount, you may reestablish a claim within the same 12-month period to care for a family member, or during or following employment with a different employer.

The definition of "family member" has been expanded to cover more people. You may provide care for:

• parents
• spouse
• children of any age
• parents-in-law
• siblings
• grandparents
• grandchildren
• domestic partners
• chosen family
• any other individuals related by blood
• any other individuals with whom you consider to be family

You can apply for Family Leave Insurance benefitsonline,in the mail,or by fax.Instructions for filing your claim are included in the application. Read all the instructions carefully before completing the application. If filing by mail or fax, don’t forget to sign and date the form.

When you apply for Family Leave Insurance benefits, we’ll need information from you, andyour family member'shealthcare provider.It isyourresponsibility to have all this information – including the medical provider part – submitted to us online, by mail, or by fax.

This is the information we need to complete your application:

1. From you:
   • Your Social Security number, contact information, and date of birth
   • The date your caregiving leave begins
   • Contact information for the medical provider who treated the family member you are caring for
   • Dates you worked for any employers in the last 18 months, the employers’ contact information, and the address(es) where you worked
   • Dates of any paid time off or other benefits you received after the last day you worked
2. Fromthe healthcare provider:
   • A medical certification to confirm your family member is in need of caregiving. Find printable guidance for the healthcare provider here.

When you complete your part online, you will get a uniqueOnline Form IDnumber to give to your family member's medical provider.They will use this number to submit their part to us online. You will be prompted to print out (or save as a PDF file) a page that has your unique Online Form ID number, along with instructions for your family member's medical provider to follow. If you do not have access to a printer wheninitially filing your application, you have a fourteen day window to return andprint the instructionswhen a printer is available. You can doso by clickingAccess claim documentsat the top of this page.

If planning ahead, you may start your online application up to 60 days in advance. To avoid deletion of your draft application: (1) within 14 days of starting theapplication, provide all information and confirm your claim; then (2) within 14 days after the start of your leave, certify and file your claim. If applying after your leave begins, you have 30 days from your first day of leave to file your application.

We would like to process your claim quickly, but can’t do it without your help.

Keep these tips in mind to avoid delays and receive your benefits faster:

1. Apply online.It’s faster than printing and mailing or faxing your application to us. If you are filing for family caregiving, it also allows your family member'smedical provider to easily complete their section online once they get the required instructions from you.Remember,it is your responsibility to give these instructions to the medical provider to complete – they arenotautomatically notified by our system. If you do apply online, don’talsosubmit that claim by mail or fax. That may delay the processing of you’re application.
2. Fill out your application completely and accurately. Read all instructions first. If you’re not sure how to answer a question, check out ourFAQorForm Look Upfor more information. If you still need help,contact us.
3. Include your Social Security numberon all correspondence.
4. Don’t fax us pictures of documents.If you want to submit a digital copy of a document (such as a birth certificate), use a free mobile app likeAdobe ScanorDropboxto transform a mobile phone picture into a high-contrast, black-and-white PDF file you can print and fax.
5. Get ready to receive your payments.Money Network/My Banking Direct will mail your prepaid debit card in a plain envelope (which might even look like junk mail), so check allyour mail carefully. If you already have a debit card from a previous Temporary Disability, Family Leave, or Unemployment Insurance claim, we will use that same card to pay benefits for new claims. If you can’t find your card,contact Money Network/My Banking Directfor a replacement.

New Jersey workers are encouraged to apply.
In order to have a valid claim forFamily LeaveInsurance, you need to have paid into the program through your employment and meet minimum gross earnings requirements.Family LeaveInsurance is available to most New Jersey workers.

Exemptions include:

• federal government employees
• out-of-state employees
• faith-based organizations
• workers that are not technically employees (such as contractors).

If your employer is covered forFamily LeaveInsurance, they are required to set up payroll contributions for you. If you believeyou are covered under the program but payroll contributions have not been made, you are still encouraged to apply as it may have been an error. If you became unemployed recently and have a need forFamily LeaveInsurance, you still may be eligible for benefits and we encourage you to apply. In that case, we will forward your application toourFamily Leave During Unemploymentsection.

Your employer is required to report your wages to the state after each calendar quarter. When your claim is under review, we consider the earnings reported for the 5 completed quarters prior to the week your leave began. The first 4 quarters of that time frame iscalled thebase year.

To qualify for Family Leave Insurance in 2023, you must have worked 20 weeks earning at least $260 weekly, or have earned a combined total of $13,000 in those four quarters (the base year).

To qualify for Family Leave Insurance in 2024, you must have worked 20 weeks earning at least $283 weekly, or have earned a combined total of $14,200 in those four quarters (the base year).

Yourregular base year periodconsists of 52 weeks and is determined by the date you apply for Family Leave Insurance benefits, as outlined in the chart below:

The wages earned during your base year will determine the amount of weekly benefits you may receive, and the total amount you can claim in a given year.

For workers who don't qualify with a standard base year, we have other ways of calculating a base year.Click herefor more information on these alternate base years.

1. First, wecalculate your average weekly wage. We do this by dividing your base year earningsby the number of base weeks.
In 2023, a "base week" was any week you earned $260 or more.
In 2024, a "base week" is any week you earn $283 or more.

2. Now, wecan determine your weekly benefit rate.Claimants are paid 85% of their average weekly wage, up to the maximum weekly benefit rate set for that calendar year.
In 2023, the maximum weekly benefit rate is $1,025 per week.
In 2024, the maximum weekly benefit rate is $1,055 per week.

For example, let’s say Steve's first day of family leave is Friday, March 1, 2024. To see how much he would receive weekly on Family Leave Insurance, we look at his reported wages for the first four of the last five completed quarters:

Quarters 1 through 4 are the regular base year and the timeframe used to calculate his benefits.

Total base year earnings:$18,200 which we divide by 45 (the number of base weeks)

This gives us anaverage weekly wageof $404.

Steve’s weekly benefit rate is 85% of his average weekly wage:$343

If Steve is taking his leave on a day by day basis, he will receive 1/7 of his weekly benefit rate for each day he claims.

Applications are processed in the order they are received. Payment of benefits will be delayed if your application is incomplete or contains missing or conflicting information.

Benefits are issued on adebit card sent to you directly by Money Network/My Banking Direct. You will receive this card in the mail in a plain, unmarked envelope once your claim is approved. Don’t lose it!

For Continuous Leave:Payments are usually issued every two weeks after the initial payment, with a one-week lag for processing time.Payment may be more or less than a one-week period.
For Non-Continuous Leave:Each day of benefits paid to you is one-seventh (1/7) of your weekly benefit rate.

Once a payment is posted, funds should be available on your debit card within three business days of the payment date. No federal income tax is withheld from your benefits unless you request a 10 percent deduction when you apply.

Family Leave benefits are paid until you: return to work, exhaust your maximum benefit entitlement, or your family member no longer needs care.

Family Caregivers do not need to take their leave all at once. You can claim Family Leave Insurance to provide care in oneconsecutive 12-week period, or on a day-by-day basis to suit your needs. However, the manner in which you choose to claim your leave will determine the duration of leave that you are entitled to.

Continuous Leave: You may receive up to 12 weeks of benefits in a 12-month period, if the benefits are claimed for one continuous period of unpaid leave.

Non-Continuous (intermittent) Leave:If you are claiming benefits on an intermittent schedule,whether it be a week, a month, or a day at a time,you may receive up to 56 individual days (8 weeks) of Family Leave benefits in a 12-month period. If you take your leave in a non-continuous manner, let us know those datesaftertaking each segment. If you are approved for Family Leave Insurance benefits but do not initially claim your maximum duration of leave when filing, we will mail you aContinued Claim Certification (FL3), which includes a schedule that you must fill out and sign – showing the days youdid not workduring the period. You will need to submit an updated schedule after each period of leave is completed.

If you plan to care for a family member and take your leave all in one continuous period, you must give your employer reasonable notice, unless there are unforeseen or emergency circ*mstances. If you plan to take intermittent days off to care for a family member, you must give your employer at least 15 days’ notice, unless there are unforeseen or emergency circ*mstances.

If you do not give your employer adequate notice, your benefit entitlement may be reduced by 14 days.We encourage you tokeep your employer informed. Having an open discussion with your employer about your need for caregiving leave will allow them to prepare for your absence and make adjustments to work schedules, if necessary. Your employer may also be able to provide insight on job protection and if you qualify for it through the federalFamily and Medical Leave Act (FMLA)or theNew Jersey Family Leave Act (NJFLA).

Here is a list of the important mail you’ll receive from us, in the order it’s typically sent:

1. C05-Confirmation of Claim Receipt: This form lets you know we received your claim. Don’t discard it! You’ll need it if you have to update any of your information (name, address, earlier return to work date, etc.).
2. D10-Eligible Notice: This form tells you that your claim has been approved for benefits.
3. D30-Ineligible Notice: This form tells you that your claim hasnotbeen approved for benefits.
4. FL3-Request to Claimant for Continued Claim Information: If your family caregiving claim is approved and you did not initially request your maximum benefit duration, you’ll receive this form so you canclaim additionalbenefits.

You also may receive one or more of the following if your application contains missing or conflicting information:

1. C10-Request to Claimant for Information: You’ll receive this form if your claim has missing or conflicting information.
2. M10-Request for Medical Information: You’ll receive this form if your caregiving claim is missing medical information, if the medical information needs further review, or if your statement conflicts with the medical provider’s statement.

For more information about specific forms or notices, see ourForm Look Up page.

The family leave program is financed 100% by worker payroll deductions. Employers do not contribute to the program.

For 2023, workers contribute 0.06% on the first $156,800 (wage cap) in covered wages earned during this calendar year. The maximum worker contribution for 2023 is $94.08. This contribution is in the form of a salary deduction that your employer takes from your weekly wages.

For 2024, workers contribute 0.09% on the first $161,400 (wage cap) in covered wages earned during this calendar year. The maximum worker contribution for 2024 is $145.26. This contribution is in the form of a salary deduction that your employer takes from your weekly wages.

Workers can receive benefits for up to twelve consecutive weeks (84 days) or up to eight weeks (56 days) of intermittent leave in a 12-month period.

The 12-month period begins on the first day of your leave.

If you have not claimed your maximum benefit amount, you may reestablish a claim within the same 12-month period to care for a different family member, or during or following employment with a different employer.

After the end of each calendar year, Form 1099-G will be available in our online system for you todownload and use when filing your federal income tax return. This form lists the total New Jersey State Family Leave Insurance (including Family Leave During Unemployment) benefits received that calendar year. This information is also sent to the Internal Revenue Service (IRS). If you receive Family Leave Insurance benefits from an approved private plan, your employer will provide you with the information required to file your federal income tax return. Family Leave Insurance benefits are not taxed by the State of New Jersey.