Official Site of The State of New Jersey

This form notifies you, as the most recent employer, that your employee’s application has been approved. The front of the form has important information about the employee’s benefits. The back lists the payment schedule, taxes, and reasons benefits could be reduced.

What do I do with this form?

Keep the form for your records. Refer to it if you have questions regarding the employee’s application. Compare the date benefits have been authorized to, to the dates the employee worked or was being paid.  

If you notice benefits being issued for days that your employee may have:

• worked 
• received vacation pay
• received sick pay

we ask that you notify the Division immediately by calling our Customer Service Line (609) 292-7060 or by faxing a corrected statement (along with the employee's Social Security number) to (609) 984-4138.

This form notifies you, as the most recent employer, that your employee’s application has not been approved and the reason why. The back page of the form gives general information regarding the qualifications for an Eligible claim and the employer’s appeal rights.

What do I do with this form?

Keep this for your records. Refer to it if you have questions regarding your employee’s claim. If you choose to appeal the decision, follow the instructions on the back of this form to appeal their Ineligible decision.

The purpose of this notice is to inform you, the employer, that disability benefit payments have been charged to your disability experience rating account. You will receive this notice each time State Disability Insurance benefit payments are made to your employee(s). The notice is mailed to you on the same day that the employee’s payment posts.

What do I do with this form?

Review this notice for accuracy. If you have reason to believe that any of the listed payments were made improperly, notify the Division of Temporary Disability Insurance in writing. It may be a good idea to keep a separate file on each employee receiving Temporary Disability Insurance benefits, and adding the DS-7C received from each benefit payment to it. This way you can keep track of the charges per employee for the life of the claim. If you receive a DS-7C with multiple employees listed, make a copy for each employee listed and add it to their separate files.

We rely on your employee (or former employee) to provide all employment history on their application, and we verify their statement against the quarterly earnings that you report to the state. In the event that we do not have enough information to approve a claim based on the reported calendar earnings and the employee's statement, you may be required to provide information. If you receive this form, it means:

• information was missing from the original application, and/or
• the information on the application conflicted with wage record
• we need to clarify the employee’s information.

What do I do with this form?

Answer all questions on both sides of the form. Sign and date the form, and fax it to 609-984-4138 within 10 days of the mailing date shown. Employers who fail to comply may face a monetary penalty.

We rely on your employee (or former employee) to provide all employment history on their application, and we verify their statement against the quarterly earnings that you report to the state. In the event that we do not have enough information to approve a claim based on the reported calendar earnings and the employee's statement, you may be required to provide information. If you receive this form, it means:

• information was missing from the original application, and/or
• the information on the application conflicted with wage record
• we need to clarify the employee’s information.

What do I do with this form?

Answer all questions on both pages. On the first page, include the employee's last physical day of work and if the employee took any paid time off, or received supplemental benefits after the last physical day of work, include the amount, date, and type of pay. On the second page, report the gross earnings for each calendar week listed on the form. Please make sure your numbers reflect the weekly earnings, not a biweekly paycheck amount. Reporting biweekly earnings could change the outcome for the employee. Sign and date the form, and fax it to 609-984-4138 within 10 days of the mailing date. Employers who fail to comply may face a monetary penalty.

We send this notice to employers who do not respond to our written requests for information within 10 days of mailing. New Jersey law requires that you must provide the employee’s wage and employment information in a timely fashion or face a penalty. A $250 penalty has been assessed to your account.

What do I do with this form?

Keep this form for your records. If you disagree with the assessment, follow the instructions on the form to dispute the penalty.

If we have not been notified of a recovery or return to work within 60 days of the last Temporary Disability payment posted, then we will mail you this form as an attempt to close out the employee’s claim.

What do I do with this form?

If applicable, enter the employee’s return to work date. Make sure to sign and date your signature at the bottom of the form. Fax this form to 609-984-4138.