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

Ministry of Social Affairs - Cerfa n° 15692*01

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

Credits : National Solidarity Fund for Autonomy (CNSA)

The form is only available in French.

The gait is free.

You must accompany this form with the following supporting documents:

  • Medical certificate less than 1 year
  • Two-sided photocopy of an identity document (valid identity document or residence permit or any other document authorising residence in France)
  • Photocopy of a proof of domicile (for persons hosted by a third party: proof of domicile and certificate of honour of the host)
  • Certificate of judgement in legal protection if you are under legal protection

Other supporting documents may be requested based on your request. The nature of these documents is specified on the form.

All documents (form and supporting documents) should be sent to the DPH 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 response at the end of a 4-month period, your request is considered to be rejected.

Go to the online administrative form

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

To whom shall I send this form ?