What if I miss the submission deadline?

If you miss the stated deadline, contact the mediator or program administrator immediately. Late submissions may still be accepted but could limit mediator review and affect scheduling or require rescheduling.

Is the form enforceable in court?

The form documents pre-mediation facts and contacts; it does not transform settlement terms into enforceable judgments unless the parties reduce an agreement to a signed settlement agreement or court order after mediation.

Can the form be submitted electronically?

Yes. Electronic submission is common. Ensure the platform provides an auditable trail, secure transmission, and appropriate authentication for sensitive or regulated information.

Do I need a notarized signature on the form?

Most programs do not require notarization for the Mediation Case Information Form itself, but specific exhibits or settlement documents may require notarization; check program rules or state requirements.

How do I indicate confidential mediator-only materials?

Label materials clearly as 'Mediator Only' or use a confidential brief field if provided. Confirm with the mediator how such materials will be handled and whether the program permits mediator-only submissions.

Who confirms settlement authority will be present?

The submitting party or counsel should state settlement authority status on the form and identify a named decision-maker. If authority is absent, describe the approval process and expected timeline.

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Mediation Case Information Form

Mediation Case Information Form

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State of New Jersey

MEDIATION CASE INFORMATION FORM

Statewide Civil, General Equity and Probate Mediation Program

DIRECTIONS: This form is to be completed by the mediator when the mediation is concluded or returned to court.

FOR OFFICE USE ONLY

DATE RECEIVED:

DATE ENTERED - AOC:

CASE DOCKET NUMBER

COUNTY

LAST NAME OF MEDIATOR

FIRST NAME OF MEDIATOR

OUTCOME / NATURE OF AGREEMENT

mediation held / full agreement on all issues

mediation held / no agreement

no mediation held / party failed to attend

mediation held / some issues pending

no mediation held / parties settled case before mediation session

no mediation held / party attended but failed to participate

SOURCE OF REFERRAL

bench

motion / request of plaintiff

referral

motion / request of defendant

consent request by both parties

MANNER OF MEDIATOR SELECTION

assigned by court

selected by parties

DATE CASE ASSIGNED TO MEDIATOR

DATE OF INITIAL MEDIATION SESSION

DATE OF FINAL MEDIATION SESSION

NUMBER OF MEDIATION SESSIONS

NUMBER OF HOURS OF PREPARATION TIME

NUMBER OF HOURS IN SESSIONS

NUMBER OF HOURS PAID BY PARTIES

DID THE ATTORNEYS SUBMIT PROPER CASE SUMMARIES?

yes no

WERE THE ATTORNEYS PREPARED FOR THE MEDIATION SESSIONS?

yes no

WERE THE PARTIES PREPARED FOR THE MEDIATION SESSIONS?

yes no

AT WHAT STAGE IN THE CASE DID THE MEDIATION SESSION TAKE PLACE? (note all that are applicable)

before any discovery

before depositions

after experts' reports served

after interrogatories and document production

after depositions

after first trial date scheduled

WAS THE TIMING OF REFERRAL TO MEDIATION APPROPRIATE?

too early appropriate time too late

HAD THIS CASE UNDERGONE ANY PRIOR CDR TECHNIQUE? (e.g. arbitration, early neutral evaluation)

yes no TYPE OF CDR APPROXIMATE DATE

IF THE CASE DID NOT SETTLE IN MEDIATION, WHAT WERE THE REASONS? (note all that are applicable)

the proper parties with authority to settle were not present

issues were too complex

one or both parties too entrenched in their positions

one or both parties did not mediate in good faith

issues were too numerous

RELATIONSHIP OF PARTIES

formal business relationship (eg. partnership, corporation)

performance of service contract

employee

family

friend

neighbor

no ongoing relationship

COMMENTS (Please use this section to note any suggestions, concerns or other comments on the pilot program.)

PLEASE RETURN TO:

AOC - CIVIL PRACTICE DIVISION

BOX 981

TRENTON, NJ 08625

FAX: 609 777-0844

Revised 6/21/2005, CN10526-english

page 1 of 1

What the Mediation Case Information Form Is

The Mediation Case Information Form collects essential case details to prepare parties and mediators before a scheduled mediation session. It typically gathers contact information, party roles, case identifiers, a short statement of the dispute, key dates, settlement authority, insurance details, and any special needs or confidentiality concerns. Courts, private mediator panels, and administrative programs use this form to allocate time, assign mediator resources, and direct pre-mediation exchanges. Completing the form accurately reduces administrative delays and helps mediators plan an efficient, focused session tailored to the dispute.

Why a Completed Form Matters

A completed Mediation Case Information Form gives mediators the factual and logistical context required to manage time, assess complexity, and anticipate evidentiary or confidentiality issues. Accurate submissions improve scheduling, reduce repeated communications, and help ensure parties arrive prepared for productive negotiation.

Who Typically Prepares and Uses This Form

The form is used by parties, attorneys, mediators, court staff, and program administrators to capture and exchange case-level information prior to mediation.

Plaintiffs / Claimants: Provide contact details, relief sought, and settlement authority.
Defendants / Respondents: Supply corporate contacts, insurer information, and decision-maker availability.
Mediators / Court Staff: Use the form to schedule sessions, identify conflicts, and plan procedural steps.

Completing the form promptly and accurately supports scheduling, confidentiality handling, and an effective mediation process for all participants.

Step-by-Step: Completing the Form Before Mediation

Use this sequential checklist to complete and exchange the Mediation Case Information Form in advance of the scheduled session.

01

Collect Records: Gather pleadings, policies, and settlement history.
02

Populate Form: Enter case number, parties, and concise dispute statement.
03

Confirm Authority: Identify whether decision-makers will attend or delegate authority.
04

Exchange Documents: Send completed forms and key exhibits to mediator and opposing counsel.

Configuring an Online Mediation Workflow

Typical online setup includes document upload, signer roles, deadlines, and secure delivery to mediator and parties.

Field	Configuration
Upload Method	PDF or DOCX accepted; convert Word to PDF for final records.
Signer Roles	Assign party, counsel, and mediator signing order where required.
Authentication	Use email or SMS codes; stronger MFA for sensitive cases.
Retention	Store executed forms with audit trail for the retention period.

Technical Needs for Secure eSubmission

Use a platform that supports authenticated signing, audit trails, and common integrations to reduce friction.

Authentication: Email link, SMS code, or stronger multifactor options.
Audit Trail: IP, timestamp, and action log retained with the document.
Integrations: Connectors for Google Workspace, Microsoft 365, or case management systems.

Verify the vendor supports data encryption in transit and at rest and can provide a BAA for HIPAA-covered workflows where required.

Typical Pre-Mediation Exchange Process

This sequence outlines how forms and documents move between parties and the mediator before the session.

Upload: Party or counsel uploads the completed form and exhibits.
Review: Mediator and opposing counsel review submitted materials.
Clarify: Mediator requests any missing details or clarifications.
Confirm: Mediator issues final agenda and logistics to participants.

Common Deadlines and Scheduling Expectations

Deadlines vary by program, but these are common timing expectations to plan around.

Form Submission Deadline:

Often 7–14 days before the mediation date to allow review.

Exchange of Exhibits:

Typically due with the form or within the same pre-mediation window.

Confidential Briefs:

Submit any confidential mediator-only briefs per program rules.

Mediator Availability Notice:

Provide windows of availability at least 14 days in advance.

Late Submission Policy:

Late forms may be accepted with less prep time or rescheduled.

Key Milestones from Filing to Session

A milestone timeline clarifies responsibilities and helps avoid last-minute issues.

01

File Form

Complete and submit the Mediation Case Information Form.

02

Exchange Documents

Share exhibits and position summaries with all parties.

03

Mediator Review

Mediator reads materials and requests missing items.

04

Session Confirmation

Mediator confirms time, location, or virtual link with participants.

Common Mistakes That Cause Delays

Entering inconsistent party names that do not match court filings or insurance policies.
Failing to list the decision-maker or indicating settlement authority is available.
Uploading unreadable exhibits or failing to label documents by exhibit number.
Missing deadlines for submission, resulting in limited mediator preparation time.

Key Security and Compliance Points

Encryption: TLS 1.2/1.3 in transit

Data at Rest: AES-256 encryption

Audit Trail: IP, timestamp, actions

HIPAA Support: BAA available

Authentication: Email, SMS, MFA

Certifications: SOC 2 Type II, ISO 27001

Risks of Incomplete or Incorrect Forms

Scheduling Delays: Session may be postponed

Limited Preparation: Mediator lacks case context

Evidence Exclusion: Exhibits may not be considered

Court Sanctions: Possible sanctions in court-ordered programs

Authority Gaps: Settlement cannot be finalized

Privacy Breaches: Unsecured uploads risk exposure

eSignature Pricing and Feature Snapshot for Mediation Workflows

Comparison of starting price and common feature indicators for vendors used to collect and execute Mediation Case Information Forms; signNow is listed first per guidance.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Verify	Verify	Verify	Verify
Bulk Send	Yes	Verify	Verify	Verify	Verify
Audit Trail	Yes	Yes	Yes	Yes	Yes
Envelope Cap	No cap	100 envelopes/user/year	Verify	Verify	Verify

Frequently Asked Questions About the Mediation Case Information Form

Answers to common questions about completing, submitting, and handling the Mediation Case Information Form.

Need help? Contact support

What if I miss the submission deadline?
If you miss the stated deadline, contact the mediator or program administrator immediately. Late submissions may still be accepted but could limit mediator review and affect scheduling or require rescheduling.
Is the form enforceable in court?
The form documents pre-mediation facts and contacts; it does not transform settlement terms into enforceable judgments unless the parties reduce an agreement to a signed settlement agreement or court order after mediation.
Can the form be submitted electronically?
Yes. Electronic submission is common. Ensure the platform provides an auditable trail, secure transmission, and appropriate authentication for sensitive or regulated information.
Do I need a notarized signature on the form?
Most programs do not require notarization for the Mediation Case Information Form itself, but specific exhibits or settlement documents may require notarization; check program rules or state requirements.
How do I indicate confidential mediator-only materials?
Label materials clearly as 'Mediator Only' or use a confidential brief field if provided. Confirm with the mediator how such materials will be handled and whether the program permits mediator-only submissions.
Who confirms settlement authority will be present?
The submitting party or counsel should state settlement authority status on the form and identify a named decision-maker. If authority is absent, describe the approval process and expected timeline.

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