NJ-2440 Statement in Support of Exclusion for Amounts Received Under Accident and Health Insurance Plan. NJ-2440 Statement in Support of Exclusion for Amounts Received Under Accident and Health Insurance Plan-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the year at the top of the form, followed by your name as the employee and your Social Security Number.
3. Next, fill in your employer's name and their identification number.
4. Indicate the periods of sickness by entering the start and end dates in the designated fields.
5. Record the number of paid days you were absent due to sickness, then subtract any initial period that is not covered under your plan.
6. Calculate your allowable sick days and multiply this by your daily rate of pay to determine total sick pay for the year.
7. Finally, ensure that an authorized representative from your employer signs and dates the form to certify its accuracy.

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