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

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Submit a Medical Certification

If your patient or their caregiver applied online for benefits, they will provide you with printed instructions for completing your medical statement (form M-01) online. If they have been approved for Temporary Disability benefits and wish to extend their claim further, they will provide you with printed instructions for completing your medical extension (form M-03) online. These instructions provide the claimant's unique Form ID, which you will need to complete your medical certification using our online system.

The information you submit is encrypted, and the system meets all state-mandated security standards. You’ll get immediate confirmation that we received your statement.