Formulaire

Declaration of Family Status and Income with the MSA (Form 14955*01)

Cerfa 14955*01 (8583)

Allows you to declare your family situation and resources to apply for certain benefits paid by the MSA.

    Fill out the form

    To whom shall I send 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 : Central Fund of the Agricultural Social Mutual Society (MSA)

    Verified 18 December 2025 - Public Service / Directorate of Legal and Administrative Information (Prime Minister)