New Jersey workers are encouraged to apply. If you can’t find your card, contact Money Network/My Banking Direct for a replacement. 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. 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 want to submit a digital copy of a document, use a free mobile app like Adobe Scan or Dropbox to transform a mobile phone picture into a high-contrast, black-and-white PDF file you can print and fax. Include your Social Security number on all correspondence.If you’re not sure how to answer a question, check out our FAQ or Form Look Up for more information. Fill out your application completely and accurately.Remember, it is your responsibility to give these instructions to the medical provider to complete – they are not automatically notified by our system. It also allows your medical provider to easily complete their section online after you pass along their part of the application. It’s faster than printing and mailing or faxing your application to us. ![]() Keep these tips in mind to avoid delays and receive your benefits faster: We would like to process your claim quickly, but can’t do it without your help. If applying after your leave begins, you have 30 days' from your first day of leave to file your application. To avoid deletion of your draft application: (1) within 14 days of starting the application, provide all information and confirm your claim then (2) within 14 days after the start of your leave, certify and file your claim. If planning ahead, you may start your online application up to 60 days in advance. You can do so by clicking Access claim documents at the top of this page. 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 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 medical provider to follow. They will use this number to submit their part to us online. When you complete your part online, you will get a unique Online Form ID number to give to your medical provider. A medical certification to confirm the period you are unable to work.The date when you expect to recover and return to work (or the date you recovered and returned to work).Dates of any paid time off or other benefits you received after the last day you worked.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 emergency/urgent care treatment or hospitalizations.Contact information for the medical provider who treated you within 10 days of the first day you were unable to work.Your Social Security number, contact information, and date of birth.This is the information we need to complete your application: It is your responsibility to have all this information – including the medical provider part – submitted to us online, by mail, or by fax. When you apply for Temporary Disability Insurance benefits, we’ll need information from you, and your medical provider. If filing by mail or fax, don’t forget to sign and date the form. ![]() Read all the instructions carefully before completing the application. You can apply for Temporary Disability Insurance benefits online, in the mail, or by fax. Instructions are included on the application. ![]() ( Haga clic aquí para español.)Īpply for Temporary Disability Insurance benefits only when you have stopped working and your doctor certifies that you are unable to work due to your pregnancy. ![]() Learn more about how these cash benefits and job protections for parents work together here. Please note that the NJ Department of Labor does not enforce these job protection laws. Take up to 12 weeks of FMLA for pregnancy/recovery and/or a related serious health condition and up to 12 weeks of NJFLA for bonding, for a total of up to 24 weeks of job protection.NJ Family Leave Act (NJFLA) provides up to 12 weeks of unpaid job-protected leave to bond with your new child.Federal Family & Medical Leave Act (FMLA) provides up to 12 weeks of unpaid job-protected leave to care for yourself before and after childbirth and to bond with your new child.Family Leave Insurance provides up to 12 weeks of cash benefits for time taken off from work to bond with your new child before your baby's first birthday.Temporary Disability Insurance typically provides 10-12 weeks of cash benefits for when you need to stop working during your pregnancy and while recovering from child birth.
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