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Welcome to the New Jersey Family Leave Insurance web application. This application allows employers to file the documentation necessary to process their employee’s New Jersey Family Leave Insurance benefits claim. Please read the following information before proceeding.

• In order to file the Employer Statement for your employee’s most recent period of family leave you will need their online form ID. This number can be found on the Employer Statement online filing instructions Block 4 or your employee can provide you with the online form ID. This online form ID cannot be obtained in any other manner.

• You will need approximately 15 minutes to complete this statement. If you exit the statement before you select the “Submit Employer Statement” button or if your computer is idle longer than 30 minutes, the application will automatically close.

Read all questions carefully!

• The information you provide will be used to determine your employee’s right to benefits. Review the Employer Statement summary before you submit the employment documentation to ensure that all information you have provided is correct. Incorrect information could result in a delay in processing your employee’s claim. Record the Confirmation Number or print the confirmation page after you submit the employment documentation. This number is proof that you successfully submitted the Employer Statement.

• Questions noted by an asterisk (*) are required and must be answered. You will not be allowed to proceed until that question has a response.

• If you require any assistance in filing the employment documentation, please call our Customer Service Section at (609) 292-7060.

Precautions are taken to keep the information you provided in this application private and secure. The online application uses a secure connection and the data submitted is encrypted. Using a shared computer to complete this application may enable others to view the employer statement.