Get Part A-1 New Jersey Family Leave Insurance Application

The PART A-1 New Jersey Family Leave Insurance Application is an essential form for individuals seeking benefits to care for a sick family member or bond with a newborn. Filling out this application accurately and completely is crucial to avoid delays in receiving your benefits.

Follow the steps to complete the application successfully.

1. Click ‘Get Form’ button to obtain the form and open it in your browser for editing.
2. Begin by filling in your full name — include your last, first, and middle names in the appropriate fields.
3. Provide your date of birth in the designated format.
4. Enter your Social Security Number carefully in the next field.
5. Select your gender by marking the appropriate box.
6. Fill in your home address, including street, apartment number (if applicable), city, state, and ZIP code.
7. Indicate your county of residence.
8. If your mailing address differs from your home address, complete that section with the relevant details.
9. State your occupation in the provided field.
10. Confirm your citizenship status by selecting 'Yes' or 'No' and, if applicable, complete additional fields regarding your alien registration number and work authorization.
11. Input the last day you worked before your family leave began.
12. Specify the desired start date for your family leave, ensuring this date is not in the future.
13. Indicate your return-to-work date or the expected date of return.
14. Select your reason for taking family leave: caring for a family member or bonding with a child.
15. Decide if you wish to have 10% of your benefits withheld for federal income tax.
16. Answer questions about any other benefits you have received or applied for during this leave period.
17. In the certification section, read the statements carefully, sign the form, and include the date. If necessary, provide a witness signature.
18. Finally, review your completed application for accuracy, save changes, and choose to download or print a copy for your records before submitting it.

Complete your New Jersey Family Leave Insurance Application online today and ensure your benefits are processed without delay.