Formulaire

Application for assistance by the holder of a disability pension paid by the Social Security (Form 11175*06)

Cerfa 11175*06 (S4151f)

Allows the holder of a disability pension paid by the Social Security to apply for a supplementary disability allowance (Asi).

This form contains the explanatory note n°51646#03.

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    Émetteur du formulaire administratif : National Health Insurance Fund (Cnam)

    Verified 19 November 2025 - Public Service / Directorate of Legal and Administrative Information (Prime Minister)