LC-3437ClaimFormOffsets (SSN,WC,Retirement,Unemployment,Etc.,) LimitationHOut ofStateCoverageMedical/Counseling/LegalassistanceNOC - NoReinstatement$14,200minimumearningsMinimum25+lives forNewBusinessStandalone12weeksFLIDCS/THAAreportsTaxableTDBwage cap$42,30026WeeksTDB$94.08 maxFLI annualContribution(0.06%)8/8/26No Latefees/ Nominimumpremiums85% ofEEAWWPREMCALC (Per10, Per 100& Per EE)White RFC(RequestforChange)60 dayWaiverLetterFLIPoster100% EEContribution20 baseweeksworkeligibilityMaxBenefit$1,055per weekCo-mingledwith CORE(can writefor 1 EE).09% taxwage tomax$161,400LC-3437ClaimFormOffsets (SSN,WC,Retirement,Unemployment,Etc.,) LimitationHOut ofStateCoverageMedical/Counseling/LegalassistanceNOC - NoReinstatement$14,200minimumearningsMinimum25+lives forNewBusinessStandalone12weeksFLIDCS/THAAreportsTaxableTDBwage cap$42,30026WeeksTDB$94.08 maxFLI annualContribution(0.06%)8/8/26No Latefees/ Nominimumpremiums85% ofEEAWWPREMCALC (Per10, Per 100& Per EE)White RFC(RequestforChange)60 dayWaiverLetterFLIPoster100% EEContribution20 baseweeksworkeligibilityMaxBenefit$1,055per weekCo-mingledwith CORE(can writefor 1 EE).09% taxwage tomax$161,400

NJ STAT Knowledge Check - HIG - Call List

(Print) Use this randomly generated list as your call list when playing the game. There is no need to say the BINGO column name. Place some kind of mark (like an X, a checkmark, a dot, tally mark, etc) on each cell as you announce it, to keep track. You can also cut out each item, place them in a bag and pull words from the bag.


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  1. LC-3437 Claim Form
  2. Offsets (SSN, WC, Retirement, Unemployment, Etc.,) Limitation H
  3. Out of State Coverage
  4. Medical/ Counseling/ Legal assistance
  5. NOC - No Reinstatement
  6. $14,200 minimum earnings
  7. Minimum 25+lives for New Business Standalone
  8. 12 weeks FLI
  9. DCS/THAA reports
  10. Taxable TDB wage cap $42,300
  11. 26 Weeks TDB
  12. $94.08 max FLI annual Contribution (0.06%)
  13. 8/8/26
  14. No Late fees/ No minimum premiums
  15. 85% of EE AWW
  16. PREM CALC (Per 10, Per 100 & Per EE)
  17. White RFC (Request for Change)
  18. 60 day Waiver Letter
  19. FLI Poster
  20. 100% EE Contribution
  21. 20 base weeks work eligibility
  22. Max Benefit $1,055 per week
  23. Co-mingled with CORE (can write for 1 EE)
  24. .09% tax wage to max $161,400