Formulaire

Application for daily parental attendance allowance (AJPP) FCA (Form 12666*03)

Cerfa 12666*03 (S7152b)

Allows a person who wishes to temporarily stop working to care for a child who is seriously ill, injured or disabled to receive an allowance.

To download the form, first click to select your place of residence.

FYI  

this form also gives you access to the cerfa no. 11423 status declaration form (which must be completed to make the request).

    Fill out the form

    To whom shall I send this form ?

    Contact the entity in charge of this form

    For details, please use the practical information sheets :

    J'ai réalisé une démarche administrative

    Je donne mon avis sur Services Publics +. L'administration concernée me répondra.

    Je donne mon avis

    Émetteur du formulaire administratif : National Fund for Family Allowances (Cnaf)

    Verified 09 March 2021 - Directorate for Legal and Administrative Information (Prime Minister)