Disability Forms

Disability forms can be obtained in our office. The form must be filed with State Disability within 30 days of the date of disability. The form consists of 3 parts.

  • Part A Claimant Information
  • Part B Medical Certificate
  • Part C Employer Information

Your form can be dropped off to us at anytime, but we cannot complete it until after your last physical day of work. You must use all accrued (earned) sick time prior to collecting disability. Information regarding the NJ Temporary Disability can be found online.