Welcome to the New Jersey Division of Temporary Disability Insurances web application for filing a transitional bonding claim for State Plan Family Leave Insurance benefits. Our records indicate that you are a new mother who received State Plan Temporary Disability Insurance benefits for a pregnancy-related disability. You can use this web site application to file your claim for State Plan Family Leave Insurance benefits only if you take family leave to bond with your child immediately following your recovery from your pregnancy related temporary disability.
You can not use web file
if you did not receive State Plan temporary disability benefits immediately prior to this Family Leave Insurance claim. You must use
Form FL1, Application For Family Leave Insurance Benefits
to file your claim.
Information about transitional bonding claims:
In most cases, you will be paid at the same weekly benefit amount as your pregnancy-related disability claim. Remember: No one may receive more than the maximum weekly benefit amount allowed by law.
No waiting week period will be required.
Your Maximum benefit amount will be either six (6) times your weekly benefit rate or 1/3 of the earnings used to determine your maximum benefit amount for your Temporary Disability Insurance claim, whichever is less. Six (6) weeks is the maximum amount of benefits anyone can receive in a 12 month period. Prior eligible Family Leave Insurance claims may affect the amount of your benefit entitlement if you have already received benefits and this claim falls into that previously established 12 month period.
Benefits are not payable for any period of time that you receive paid time off from your employer. Your maximum entitlement may be reduced up to two weeks if your employer required you to take paid time off.
You and your employer have the right to appeal a determination made on your claim.
Family Leave Insurance benefits are subject to federal income tax. These benefits are not subject to New Jersey state income tax. You can request 10% of your benefits be withheld for federal income tax.
It is your responsibility to file your claim promptly. Your claim must be filed within 30 days of the beginning of your bonding leave. Benefits may be denied or reduced if the claim is filed late.
Tips for filing online
You will need the logon PIN that was mailed to you on Form FL2, New Mother Bonding to gain access to the system.
You must answer all questions. If you do not answer all questions, your application will not be processed.
Do not use your browser’s Forward or Back buttons. Use the buttons provided in the application for navigation.
Allow approximately 15-20 minutes to complete the application. If you leave the form for any reason before completing the application, all of your information will be erased and you will have to start over.
Upon completion of the online application you must select the "FILE MY CLAIM" button to send the application. Exiting before submitting the application will cause any information you entered to be lost. After selecting the "FILE MY CLAIM" button, wait for a confirmation page to appear. When the confirmation page appears, write down the "Confirmation Number" and/or print the confirmation page. Your "Confirmation Number" is proof of filing your claim.
Data Privacy and Security
The information collected as a result of your application for Family Leave Insurance benefits is private data and cannot be released except when authorized by state or federal law, by a court order, or with your permission.
The information you or your employer(s) provide may be used for any New Jersey Department of Labor and Workforce Development business. It may be shared with other state or federal agencies that determine your eligibility for Medicaid, Food Stamps, Social Security, or other state or federal benefits and programs. It may also be shared with other Federal Agencies and State Departments.
This online application uses a Secure Socket Layer (SSL) for security. Data submitted using this application is encrypted. You should be aware that using a shared computer may enable others to view your personal information.
To file a transitional bonding claim for Family Leave Insurance click “continue” below: