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Quick answer: Fax a paper New Jersey Temporary Disability application (DS-1) or Family Leave application (FL-1) to the Division of Temporary Disability and Family Leave Insurance at 609-984-4138. Fax every page, including the page your healthcare provider completes, with your name and Social Security number on each. Missing information the Division asks for goes to the same fax. If your employer has a private disability plan, your claim goes to that insurance carrier instead.
You can’t file before your leave begins.
New Jersey runs its Temporary Disability Insurance (TDI) and Family Leave Insurance (FLI) programmes from one Division in Trenton, and one fax number serves both. You can also apply online at myleavebenefits.nj.gov. The paper route is the DS-1 for your own illness, injury or pregnancy, and the FL-1 for caring for a family member or bonding with a new child.
One fax, with three exceptions
Checked on nj.gov on 16 October 2026.
| What you’re sending | Fax | Source | Checked on |
|---|---|---|---|
| Temporary Disability application (DS-1) | 609-984-4138 | DS-1 (6/19); TDI FAQ | 16 Oct 2026 |
| Family Leave application (FL-1) | 609-984-4138 | FL-1 (6/19); FLI FAQ | 16 Oct 2026 |
| Missing information, or a form the Division sent you to sign and return | 609-984-4138 (some forms set a 10-day deadline) | The Division’s form lookup | 16 Oct 2026 |
| A claim under a private disability plan | Not the Division: your employer’s insurance carrier | Employer notice PR-1 | 16 Oct 2026 |
| A Disability During Unemployment claim | 609-292-9209 | Division contact page | 16 Oct 2026 |
| An appeal of a Division decision | Use the fax on your decision notice: the Division’s appeals page gives 609-984-4138, the Appeal Tribunal lists 609-292-2438 | Division appeals page; Appeal Tribunal page | 16 Oct 2026 |
Getting the DS-1 right
- The healthcare provider’s page. Part of the DS-1 is for your doctor or other provider to complete. The Division tells providers that either they or you can fax or mail the finished application, so agree who sends it.
- Your last day of work. The form asks for your last physical day of work before the disability, and the Division’s forms call that date critical to deciding a claim.
- Every employer. If you’ve had more employers than the page has room for, copy the page and add them.
- Workers’ compensation. The form asks whether you or your employer have filed, or plan to file, a workers’ comp claim. If a workers’ comp carrier has denied your claim for a work-related disability, you can still apply for TDI.
Older versions of the DS-1 were printed on both sides and told you to fax the back of every page as well. Whichever version you have, fax all of it, and keep the confirmation page with the date and page count.
Some forms the Division sends you have to be signed, dated and faxed back within 10 days of the mailing date shown.
Family Leave: the FL-1
The FL-1 goes to the same 609-984-4138. It asks whether you’re taking all 42 days of Family Leave benefits in a row, because you don’t have to: you can claim one continuous period or individual days, and partial schedules go in Part D. It also asks whether you gave your employer at least 15 days’ notice.
Disabled while on unemployment
If you become disabled while collecting unemployment benefits, stop certifying for unemployment and apply for Temporary Disability. Those claims are handled by the Division’s Disability During Unemployment unit, which has its own fax, 609-292-9209.
Appealing a decision
Every decision notice explains how to appeal it. The Division’s appeals page says you can appeal online, or in writing with your name, Social Security number, address and signature, faxed to 609-984-4138 or posted to P.O. Box 387. Do it within 21 calendar days of the mailing date. If you’re past the deadline, say why the appeal is late.
The Appeal Tribunal, which hears state-plan disability disputes, lists its own fax for incoming appeals: 609-292-2438. With two published numbers, use the one printed on your decision notice, and keep the confirmation page as proof of the date.
Online, by post or by phone
Post the application to the Division of Temporary Disability and Family Leave Insurance, P.O. Box 387, Trenton, NJ 08625-0387, apply online at myleavebenefits.nj.gov, or call 609-292-7060 (8:00 a.m. to 4:30 p.m., Monday to Friday). The Division also lists an email address, dtdi@dol.nj.gov.
Every page has to arrive, the provider’s included: Municorn Fax sends the DS-1 or FL-1 to 609-984-4138 and keeps a confirmation page showing each one went through. EveryFax covers faxing from a computer or email account.
Frequently Asked Questions
Can I apply for New Jersey Temporary Disability online?
Yes, at myleavebenefits.nj.gov. The paper DS-1 can be faxed to 609-984-4138 or posted to P.O. Box 387, Trenton, NJ 08625-0387.
Who can fax the DS-1, me or my doctor?
The Division tells healthcare providers that either they or the applicant can fax or mail the completed application.
Is the Family Leave fax the same number?
Yes. The FL-1 also goes to 609-984-4138.
Is my medical information protected?
The DS-1 says the program isn’t a “covered entity” under HIPAA, but New Jersey law keeps the Division’s claim records confidential and closed to public inspection.
Sources
- DS-1, New Jersey Temporary Disability Benefits Application (6/19): fax, provider page, last day of work, workers’ comp question, HIPAA note. Checked 16 October 2026.
- FL-1, New Jersey Family Leave Benefits Application (6/19): fax, 42 days, 15 days’ notice, Part D. Checked 16 October 2026.
- Division FAQ: Temporary Disability Insurance: mail and fax, workers’ comp denials. Checked 16 October 2026.
- Division FAQ: Family Leave Insurance: FL-1 fax, continuous or daily claims. Checked 16 October 2026.
- Division, appeals: written appeals, 609-984-4138, 21 days. Checked 16 October 2026.
- About the Appeal Tribunal: fax for incoming appeals 609-292-2438. Checked 16 October 2026.
- Division, contact us: hours, Disability During Unemployment fax 609-292-9209. Checked 16 October 2026.
- The Division’s form lookup: missing information, 10-day returns. Checked 16 October 2026.
- Division leaflet PR-143: no filing before leave starts, email and phone. Checked 16 October 2026.
- PR-151, what medical providers need to know (3/26): who can fax the application. Checked 16 October 2026.
- Employer notice PR-1: state plan versus private plan. Checked 16 October 2026.
- Older DS-1 (10/16): faxing the back of each page. Checked 16 October 2026.
