Formulaire

Application or renewal of disability benefits (AAH, PCH, CMI, accommodation ...) (Form 15692*01)

Cerfa 15692*01

This form allows you to request or renew various services (AAH, PCH, CMI, accommodation,...) from the MDPH: titleContent.

The form is available in French only.

The procedure is free of charge.

This form must be accompanied by the following supporting documents:

• Medical certificate less than 1 year
• Photocopy on both sides of a proof of identity (valid identity document or residence permit or any other document authorizing residence in France)
• Photocopy of proof of domicile (for persons hosted by a third party: proof of domicile and attestation on the host's honor)
• Certificate of judgment in legal protection if you are under legal protection

Additional proof may be requested depending on your request. The nature of these supporting documents shall be specified on the form.

All documents (form and supporting documents) should be sent to the MDPH of your place of residence, preferably by registered letter with notice of receipt.

The response to your request is within 4 months. If you do not receive a reply within 4 months, your request will be considered rejected.

Fill out the form

Émetteur du formulaire administratif : Ministry of Social Affairs

Verified 21 June 2022 - Directorate for Legal and Administrative Information (Prime Minister)