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Temporary Disability benefits are available to eligible domestic or sexual violence victims/survivors that are unable to work due to a physical or mental illness, injury or disability. Temporary Disability benefits are only available if you have an illness, injury, or disability. You may claim up to a maximum of 26 weeks of benefits under this program, for as long as a medical professional will certify. If your loved one is ill, injured, or disabled, and you need to take time off work to care for them, you can apply for Family Leave Insurance benefits for caregiving.

Family Leave Insurance benefits are available to an eligible victim/survivor or the loved one of a victim/survivor. You can receive benefits if you are unable to work or if you need time off to handle matters related to your situation. As a caregiver, you can receive benefits if you are unable to work because you need to care for a loved one who is a victim/survivor. You may claim up to a maximum of 12 consecutive weeks or 56 individual days in a 12-month period. 

Allowable uses as a victim/survivor or for supporting a victim/survivor include:

• Seeking medical attention, therapy, victim advocacy, or legal services
• Safety planning or escaping abuse, such as staying in a domestic violence shelter
• Attending or preparing for court
• Recovering at home

For information on eligibility for Temporary Disability benefits, click here.  

For information on eligibility for Family Leave benefits, click here. 

Print and complete the paper "FL-1 Family Leave Application." 

When choosing your reason for Family Leave on question 12, select “Care of family member” even if you are caring for yourself. Then, write in “Coping with Domestic (or Sexual) Violence” in the blank space next to it.

Read all the instructions carefully first. Don’t forget to sign and date the form.

Be sure to complete all of Parts A, B & C. If Part C (medical documentation) does not apply to you, you may substitute it with one of the following:

• Domestic violence restraining order
• Letter/document from county or municipal prosecutor
• Documentation of conviction of offender for the domestic violence/sexually violent offense
• Certification from a certified Domestic Violence Specialist or director of designated domestic violence or Rape Crises center
• Other documentation from a social worker, clergy member, shelter worker, or other professional             

Attaching one of these documents is only necessary if you do not have any medical documentation for yourself or the person you are caring for.

Once all parts are completed, you may fax the application to 609-984-4138 or mail to the division at:

Division of Temporary Disability and Family Leave Insurance
PO Box 387
Trenton, New Jersey 08625-0387.

At this time, we cannot take online Family Leave applications for domestic/sexual violence due to technical limitations.

Apply for Temporary Disability Insurance benefits online or print and complete the "DS-1 Temporary Disability Application." Read all the instructions carefully first. If filing by mail or fax, don’t forget to sign and date the form.

When you apply for Temporary Disability Insurance benefits, we’ll need information from you and your medical provider. It is your responsibility to have all this information – including the medical provider part – submitted to us online, by mail, or by fax. Once all parts are completed, you may fax the application to 609-984-4138 or mail to the division at:

Division of Temporary Disability and Family Leave Insurance
PO Box 387
Trenton, New Jersey 08625-0387

Temporary Disability Insurance and Family Leave Insurance are wage replacement programs and they do not provide job protection. However, your job may be protected under the federal Family and Medical Leave Act (FMLA), New Jersey Family Leave Act (NJFLA), or the New Jersey Security and Financial Empowerment Act (SAFE).

Click here to learn more about job protection.