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Welcome to the New Jersey Temporary Disability Insurance web application. This application allows employers
to file the documentation necessary to process their employee’s New Jersey Temporary Disability 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 temporary disability 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.
• Be sure to read all questions carefully!
• This information will be used to determine your employee’s right to benefits. Be sure to 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. We suggest that you record the Confirmation Number or print the confirmation page
after you submit the employment documentation. The Confirmation Number is proof that you 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 provide in this application private and secure. The on line application is using a secure connection.
Data submitted using this application is encrypted. You should be aware that using a shared computer may enable others to view the employment certification.
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