Division of Temporary Disability and Family Leave InsuranceURL reading ( My Leave Benefits . NJ . Gov )

Print an Application

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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. 

An African-American man with an injured leg doing physical therapy

Temporary Disability Insurance Application (DS-1)

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Smiling elderly Asian woman in a wheelchair in front of her house, with her daughter kneeling beside her

Family Leave Insurance Application (FL-1)

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