How to Complete the New Jersey FL-1 Family Leave Insurance Application

New Jersey’s FL-1 is the paper application for Family Leave Insurance benefits, and you complete it in four parts: your personal and leave information, your recent employment history, a medical certification if you’re caring for a sick family member, and a schedule if you’re taking leave intermittently. You can also apply online at myleavebenefits.nj.gov, which the state processes faster and which lets the healthcare provider submit their certification electronically.¹ Whichever route you choose, file within 30 days of the day your leave begins.

Before You Fill Out the Form

FL-1 is for two kinds of leave: bonding with a new child (birth, adoption, or foster placement) or caring for a family member with a serious physical or mental health condition. New Jersey defines family broadly, including spouse, domestic partner, child, parent, parent-in-law, sibling, grandparent, grandchild, anyone related by blood, and anyone you consider family.¹

To qualify for 2026 benefits, you need enough recent earnings in your base year (the first four of the last five completed calendar quarters before your claim): either 20 weeks at $310 or more per week, or $15,500 total across the four quarters.¹ Pull your recent pay stubs or W-2s before you start; the state verifies wages against employer-reported records, and having your own numbers ready helps you spot errors that would slow your claim down.

One check to run first: ask your employer whether they use an approved private plan instead of the state fund. If they do, you file with that carrier, not on the FL-1, and sending the state form will delay everything.¹

Online or Paper

The state recommends applying online. It processes faster, and your family member’s provider can submit the medical certification through the same system instead of returning a paper form to you.¹ If you apply online, do not also mail or fax a paper FL-1. Duplicate applications create confusion and slow the claim.

You can start the online application up to 60 days before your leave begins. Once you start a draft, you have 14 days to enter your information and confirm the claim, then another 14 days after leave begins to certify and officially file. If either window closes, the system deletes your draft.¹ Some applicants are also asked to verify their identity through ID.me after submitting.

If you’d rather use the paper FL-1, download and print it from the Department of Labor’s website, then mail or fax the completed form. The rest of this article walks through each part of that paper form.

Part A: Your Information and Leave Details

Every claimant fills out Part A. It collects your Social Security number, home address, contact information, and date of birth, along with the date your leave began or will begin, the date you expect to return to work, and the reason for leave (bonding or caregiving).² Bonding applicants provide the child’s date of birth or placement date. You’ll also identify the person you’re caring for or bonding with and your relationship to them.

Part A includes a certification section where you report any other payments you’re receiving during the leave period: paid time off, pension payments, workers’ compensation, Social Security disability, or unemployment benefits. The state needs this to calculate what you’re owed. Leaving something out can create an overpayment you’ll be asked to repay later.

Part B: Employment Information

Part B is your recent work history. Starting with your most recent employer, list every employer you worked for in the six months before your leave began.² For each one, enter the company name and address, your last physical day of work, and whether you received any pay after that day for vacation, sick, or personal time.

Note that the online application asks for 18 months of employer history rather than six.¹ If you switch from paper to online partway through, have the longer history ready.

Part C: Medical Certification for Caregiving Claims

Part C applies only to caregiving claims. Skip it entirely if you’re bonding with a new child.

Part C has two sections. The first is completed by the care recipient’s healthcare provider and includes the diagnosis, when the condition began, and the estimated period during which your caregiving is needed.² The state reviews diagnosis codes to verify claims, so the provider needs to complete this fully.³ The second section is signed by the care recipient, confirming they need your care.

The provider is not notified automatically. You have to hand them the paper form, or if you applied online, the printed instruction sheet with your Online Form ID. Most delays happen right here, so follow up with the provider’s office if you haven’t heard back within a few days.

Part D: Intermittent Leave Schedule

Part D is only for intermittent leave. If you plan to take a few days at a time, or leave in separate weeks rather than one continuous block, fill out Part D with your planned schedule.² If you’re taking your full 12 weeks consecutively, leave Part D blank.

Something to know before you commit to intermittent leave: the maximum drops from 84 days of benefits (12 continuous weeks) to 56 individual days within a 12-month period.¹ You’ll also need to return a signed Continued Claim Certification (Form FL-3) after each segment of leave, and the state won’t release payment for those days until it receives the signed schedule.⁴

Where to Send the Completed Form

Mail the completed FL-1 to Division of Temporary Disability & Family Leave Insurance, P.O. Box 387, Trenton, NJ 08625-0387, or fax it to 609-984-4138.⁴ If you fax, avoid sending phone photos; use a scanning app to convert them to high-contrast black-and-white PDFs first.

The 30-Day Filing Deadline

If your leave has already started, file within 30 days of your first day of leave.¹ Missing that window doesn’t automatically disqualify you, but you’ll need to show the state it wasn’t reasonably possible to file on time.⁵

For bonding, there’s a second outside deadline. Benefits for a newborn must be claimed before the child’s first birthday. Benefits for an adopted or foster child must be claimed within 12 months of the placement date.¹

Notice to Your Employer

Filing the FL-1 with the state is separate from telling your employer. New Jersey law requires 30 days’ advance notice for foreseeable bonding leave. Without a good reason for shorter notice (an unexpected early delivery, for example), your benefits can be reduced by two weeks. For intermittent caregiving leave, the notice period is 15 days before the first day of leave, unless an emergency makes prior notice impossible.⁶

What You’ll Be Paid

Your weekly benefit is 85 percent of your average weekly wage during the base year, capped at $1,119 per week in 2026.⁷ Continuous leave pays up to 12 weeks. Intermittent leave pays up to 56 days within a 12-month period.¹

Payment comes through a prepaid debit card mailed to your address. Direct deposit is available only in a narrow situation: if you received unemployment insurance benefits by direct deposit within the last 28 days and your claim was routed through the Family Leave During Unemployment program.⁸ For most people, the debit card is the only option.

After You File

Applications are processed in the order received. The state reviews your employment history, verifies wages against employer-reported records, and for caregiving claims confirms the medical certification. There’s no published turnaround time, so check status through the online portal rather than waiting on mail.

When the review finishes, the Division sends a Notice of Determination with the decision, your weekly benefit amount, and the approved leave period.¹

If Your Claim Is Denied

You have 21 calendar days from the date the determination was mailed to appeal. File the appeal online through the myleavebenefits portal, by fax to 609-984-4138, or by mail to the P.O. Box 387 address in Trenton. Written appeals must include your name, Social Security number, address, and signature.⁹

Late appeals can still be submitted, but you’ll need to explain the delay, and an appeals examiner decides whether to accept it. The Division may try to resolve the issue informally first. If that doesn’t settle it, the case goes to an appeal tribunal and you’ll get a notice to register for a telephone hearing. Register no later than 3 p.m. the business day before the hearing; you can bring witnesses and an attorney on the call.⁹

If the tribunal decision includes an overpayment demand and repaying it in full would cause hardship, you can request a payment plan by calling 609-633-7663 or applying online.⁹

One Thing the FL-1 Does Not Do

Family Leave Insurance replaces part of your wages. It does not protect your job. Job protection, if you’re entitled to it, comes from the federal Family and Medical Leave Act or the New Jersey Family Leave Act, each with its own eligibility rules. If keeping your position matters, confirm your rights under those laws separately from filing the FL-1.

1
My Leave Benefits. Family Leave Insurance
2
New Jersey Department of Labor and Workforce Development. NJ Family Leave Insurance Application Form FL-1
3
Division of Temporary Disability and Family Leave Insurance. Information for Healthcare Providers
4
Division of Temporary Disability and Family Leave Insurance. FAQ: Family Leave Insurance
5
FindLaw. New Jersey Code 43:21-49 – Notices and Proof of Disability
6
New Jersey Department of Labor and Workforce Development. New Jersey Temporary Disability Benefits Law
7
Division of Temporary Disability and Family Leave Insurance. Information for Employers
8
Division of Temporary Disability and Family Leave Insurance. How You’ll Get Your Money
9
My Leave Benefits. Appealing a Decision