Fillable Application for Family Allowance Payments (Québec)

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Application for Family Allowance Payments (Québec)

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  • 157 other fields

Country of origin: CANADA
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i
Application for Family Allowance Payments
Family Allowance
Information
LPF-800A (2019-11)
Entitlement
You are entitled to Family Allowance payments if you meet
all of these conditions:
• You or your spouse is responsible for the care and
education of a child under age 18.
• The child is living with you OR was living with you when
he or she was placed by a youth centre AND you are
paying the financial contribution required by the centre.
• You are living in Québec.
1
• Either you or your spouse is one of the following:
— Canadian citizen;
— protected person;
2
— permanent resident;
2
— temporary resident who has been living in Canada
for the past 18 months.
2
You are not entitled to Family Allowance payments if:
• You receive financial aid from the Programme régional
d’accueil et d’intégration des demandeurs d’asile
(PRAIDA) or because you are a child’s foster family or a
subsidized guardian;
• You are exempted from paying income tax by Revenu
Québec;
• Your child is married or in a de facto union and tax
credits were transferred to his or her spouse;
• You are a refugee claimant.
In the case of a blended family, the application must be
filed by the parent of the child.
Do you need to file an Application for Family
Allowance Payments?
You do not need to file an application with our agency in order
to register a baby born in Québec: the Directeur de l’état civil
will provide us with the required information.
However, you must fill out this form in the following
situations:
• Your child was born in Québec and we ask that you
file an application because we require more information
(check “Birth in Québec” in section 1).
• You are an immigrant or become a Québec resident
(check “Arrival in or return to Québec” in section 1).
• Your child arrives in or returns to Québec (check “Arrival
in or return to Québec” in section 1).
• You live in Québec but your child was born outside
Québec (check “Arrival in or return to Québec” in
section 1).
• You obtain custody of a child (check “Change in
custody” in section 1 and fill out the Information on
Child Custody form).
• You retain custody of a child following the breakdown
of your union or the death of your spouse and you were
not previously receiving Family Allowance payments
(check “Change in custody” in section 1 and fill out the
Information on Child Custody form).
• You obtain shared custody of a child (check “Shared
custody” in section 1 and fill out the Information on
Child Custody form).
• You adopt a child (check “Adoption” in section 1).
You can apply for Family Allowance payments directly on our website at www.retraitequebec.gouv.qc.ca. You will
avoid any postal delays and we can confirm immediately that we have received your application.
1
Within the meaning of the Québec Taxation Act
2
Within the meaning of the Immigration and Refugee Protection Act
(Statutes of Canada, 2001, c. 27)
ii
LPF-800A (2019-11)
• At our request, because your child was placed by a
youth centre and the financial contribution was not paid
for more than 12 months and:
— you resume payment of the required contribution;
OR
— the child is back home (check “End of placement
or resumption of payment of the financial
contribution required by the youth centre”).
In cases of shared custody
• The Taxation Act provides for Family Allowance
payments to be made to both parents at the same time,
if the percentage of custody time is between 40% and
60% for each parent on a monthly basis. Example: 40%
= 3 days a week, 50% = every other week, 60% = 4
days a week.
• In accordance with the Act, we must consider the actual
custody time. Therefore, you must notify us if custody
is shared. In addition, we cannot take into account any
agreement entered into by the two parents.
• The amount to which you are entitled is equivalent to half
of the amount that you would have received for the child
if the child were not in shared custody.
• If the child gives entitlement to a Supplement for
Handicapped Children, that amount is shared as well.
Payment dates
Your Family Allowance payments will be made on the first
working day of each quarter, that is, four times a year:
• in July for July, August and September;
• in October for October, November and December;
• in January for January, February and March;
• in April for April, May and June.
You can receive your payments on a monthly basis.
However, to do so you must apply online or by telephone.
The payment dates are provided on our website at
www.retraitequebec.gouv.qc.ca.
Who receives the Family Allowance payments?
Family Allowance payments are made to only one
person per family, who is generally the person who filed the
application. However, if your spouse already receives Family
Allowance payments, he or she will receive the payments for
each child indicated in this application.
Conjugal status
In order for us to determine the amout of your Family Allowance
payments, you must provide information about your conjugal
status, whether or not you have a spouse. If you have been
living with a de facto spouse for at least 12 months, you must
inform us. If your spouse lives outside Québec, you must
provide his or her address, whether you are married or de
facto spouses.
Family Allowance amounts
The Family Allowance is set on the basis of the following
four criteria:
• number of dependent children under 18 living with you;
• number of children in shared custody;
• your family income;
• your conjugal status (with or without a spouse).
1
Note that we can make Family Allowance payments for a
retroactive period of 11 months before the date on which we
received your application, if you met the eligibility requirements
during that period.
Income tax returns used to set payment amounts
In order to obtain Family Allowance payments, you and your
spouse must file a Québec income tax return every year, even
if one of you does not have any income to report.
If you or your spouse earned income outside Québec over the
past 24 months, you must provide the additional information
requested on the form (see section 6).
You can use CalculAide on our website at
www.retraitequebec.gouv.qc.ca to find out the amount
of the Family Allowance payments to which you could
be entitled.
1
Within the meaning of the Québec Taxation Act
iii
LPF-800A (2019-11)
Information on documents provided as proof
When documents are required as proof, you must provide clear
and legible copies. If necessary, we may request the original
documents or certified true copies.
Proof of immigrant status in Canada
If you and your spouse, if applicable, are not Canadian citizens,
OR if your status has changed in the past 12 months, you
must provide proof of your immigrant status in Canada if it
has not previously been provided to us. Note that the proof
must cover a period of 12 months prior to your application.
All the information you need is given on the Immigrant Status
in Canada form.
Proof to be provided for the child
You are not required to provide any documents as proof in the
following situations:
• The child was born in Québec and was not adopted.
• The child has already given entitlement to Family
Allowance payments.
Otherwise, you must provide us with one of the following
documents, depending on the situation:
If the child was born outside Canada:
• one of the following documents in the child’s name on
which the child’s family name, given name(s) and date
of birth appear:
— confirmation of Permanent Residence
(IMM 5292 or IMM 5688);
— permanent resident card (both sides);
— certificate of Canadian citizenship (both sides);
— Canadian passport;
— Interim Federal Health Certificate of Eligibility;
— Protected Person Status Document;
— Record of Landing form (IMM 1000);
— study permit;
— temporary resident permit;
— visitor record.
OR
• one of the following documents in the parent’s name on
which the child’s family name, given name(s) and date
of birth appear:
— study permit;
— temporary resident permit;
— visitor record;
— work permit.
If the child was born in Canada, but outside Québec:
• a birth certificate issued by the vital statistics office of
the province or territory of birth.
If the child was adopted:
• one of the following documents can also be accepted:
— placement order from the Court of Québec;
— recognition of an adoption judgment from the
Court of Québec;
— adoption judgment from Québec or another
Canadian province or territory, or the Declaration
of Inuit Customary Adoption Form;
— birth certificate issued by the vital statistics office
of a Canadian province or territory;
— certificate of registration of adoption from the
Court of Québec.
Proof of the child’s presence in Québec
You must provide additional proof if one of the following
situations applies to the child for whom you are completing
this form:
• the child arrived alone in Québec, without his or her
parents; or
• the child was born outside Québec and one of the
child’s parents is a Canadian citizen, or one of the child’s
parents is a permanent resident who has returned to
Québec;
• The child has already given entitlement to Family
Allowance payments and has returned to Québec.
In such a case, provide ONE of the documents listed below.
The document must show the child’s family name, given
name, date of birth and address in Québec.
— official report card or confirmation of school
attendance that is signed by the principal of the
school and includes the school’s seal along with
the name and address of the respondent;
— confirmation of daycare attendance signed
by the director of the daycare facility. The
document must give the name and address of
the daycare as well as the name and address of
the respondent;
— any medical document proving that you are
responsible for the child’s medical appointments;
— a Québec vaccination booklet giving the child’s
family name, given name(s) and the vaccination
dates since your arrival in or return to Québec.
iv
LPF-800A (2019-11)
Proof of residence in Québec
If you have lived outside Québec at some point during the
past 24 months, documents showing your current address
are required as proof of residence in Québec, if such proof has
not previously been provided to us.
You must provide two different documents. A list of
the documents accepted as proof is provided below.
The documents must be issued in your name or in the name of
your spouse if your spouse lives with you at the same address.
Documents accepted as proof
• Apartment lease (all pages)
• Attestation from the employer
• Deed of purchase of residential property
• Home insurance policy
• Invoice from an energy company (heating, electricity)
• Invoice from an Internet service provider or a cable
television or telephone company
• Letter from Emploi-Québec confirming your status as
a beneficiary under the Social Assistance Program or
the Social Solidarity Program
• Letter from the Régie de l’assurance maladie du
Québec confirming your eligibility for the Québec Health
Insurance Plan;
• Municipal or school tax notice
• Proof of registration in an educational institution in
Québec
• Québec driver’s licence
Supplement for the Purchase of School Supplies
The purpose of the supplement is to help families with the
purchase of school supplies. This financial assistance of $100
is paid yearly in July for each child aged 4 to 16 who is eligible
for Family Allowance payments, and each child aged 4 to 17
who is eligible for the Supplement for Handicapped Children.
The amount is indexed in January of each year. You do not
have to file an application to receive it. Each parent who share
custody of a child will receive half the supplement ($50).
Access to documents held by public bodies and
the protection of personal information
The personal information collected on this is needed to
study your application. Failure to provide the requested
information in the mandatory sections may result in
a delay or a refusal to process your application. Only
authorized employees have access to the information and it
is only disclosed to other persons or agencies for verification
in cases provided for by law. It can also be used for research,
assessment, analysis or survey purposes. Pursuant to the
Actrespecting Access to documents held by public bodies
and the Protection of personal information, you may consult
your personal information and have it corrected.
For more information
Online
By telephone
Québec region: 418 643-3381
Montréal region: 514 864-3873
Toll-free: 1 800 667-9625
1
year month day
French English
area code area code
F
M
F
M
year month day
Application for Family Allowance Payments
Family Allowance
2. Information about you
Give your Social Insurance Number
Please print.
1. Reason for your application
4. Information about your spouse
3. Information about your conjugal status (complete even if your spouse lives outside Québec)
Retraite Québec LPF-800A (2019-11)
Sex Family name Given name
Date of birth Language of correspondence Your mother’s family name at birth (last name only)
Your address (number, street, apartment)
City Province Country Postal code
Telephone Other Extension
Why are you filing an application? (Check only the box that corresponds to your situation. If you are not sure which one to choose, refer to
the section entitled “Do you need to file an application for Family Allowance payments?” on page i of the Information section.)
a)
Change in custody
b)
Shared custody
c)
Adoption
d)
Birth in Québec
e )
Arrival in or return to Québec
f)
End of placement or resumption of payment of the financial contribution required by the youth centre
If you chose a) or b), you must also fill out the Information on Child Custody form.
Sex Family name Given name Social Insurance Number
Date of birth His or her mother’s family name at birth (last name only)
Are you and your spouse living at the same address?
Yes No
What is your current conjugal status? (Refer to page ii of the Information section.)
a)
I have a spouse
b)
I do not have a spouse
Date on which you began
living together
year month day
Date on which you and your spouse had your first child
together, if your spouse is the mother or father of one of your
children (by birth or adoption):
year month day
Date of your marriage
or civil union:
year month day
Specify:
You and your former spouse have not lived together
for at least 90 days following the breakdown of your union.
Date on which you stopped
living together:
year month day
Your spouse is deceased.
Date of death:
year month day
You have always lived alone.
0201800 PA
2
5. Citizenship
You
Your spouse (If applicable)
Retraite Québec LPF-800A (2019-11)
Are you a Canadian citizen? Yes No
(You must complete section 6 in both cases.)
If so, since when?
Since birth
Since
year month day
Is your spouse a Canadian citizen? Yes No
(You must complete section 6 in both cases.)
If so, since when?
Since birth
Since
year month day
6. Residency (Check each situation that applies to you and, if applicable, to your spouse.)
a)
You have been living in Québec for at least the past
24 months.
If you checked the statement, specify since when:
Since birth
Since
year month day
If you have been living in Québec for less than
24 months, check situation b) or c).
a)
Your spouse has been living in Québec for at least
the past 24 months.
If you checked the statement, specify since when:
Since birth
Since
year month day
If he or she has been living in Québec for less than
24 months, check situation b) or c).
b)
You are living in Québec but lived outside Canada
at some point in the past 24 months.
Date you arrived in Québec
year month day
Date you arrived in Canada
year month day
Date you left Québec in the
case of a return to Québec
year month day
Complete the Statement of Foreign Income form.
Provide proof of your residence in Québec
(refer to page iv of the Information section).
b)
Your spouse is living in Québec but lived outside
Canada at some point in the past 24 months.
Date he or she arrived
in Québec
year month day
Date he or she arrived
in Canada
year month day
Date he or she left Québec
in the case of a return
to Québec
year month day
Complete the Statement of Foreign Income form.
c)
You are living in Québec but lived in another Canadian
province or territory at some point in the past
24 months.
Date you arrived in Québec
year month day
Date you left Québec in the
case of a return to Québec
year month day
If you lived in another Canadian province or territory
on 31 December of last year, provide your Notice of
Assessment from the Canada Revenue Agency for:
– the past two years if you arrived in Québec
between 1 January and 31 May;
– last year if you arrived in Québec between
1 June and 31 December.
Provide proof of your residence in Québec
(refer to page iv of the Information section).
c)
Your spouse is living in Québec but lived in another
Canadian province or territory at some point in the
past 24 months.
Date he or she arrived
in Québec
year month day
Date he or she left Québec in
the case of a return to Québec
year month day
If he or she lived in another Canadian province or
territory on 31 December of last year, provide his or
her Notice of Assessment from the Canada Revenue
Agency for:
– the past two years if he or she arrived in Québec
between 1 January and 31 May;
– last year if he or she arrived in Québec between
1 June and 31 December.
d)
You are currently living outside Québec.
Complete the Person Living Outside Québec form,
available at www.retraitequebec.gouv.qc.ca.
d)
Your spouse is currently living outside Québec.
We will contact you to find out the amount of the income
he or she earned outside Québec.
Note: Complete the Immigrant Status in Canada form only if neither you nor your spouse is a Canadian citizen.
Give your Social Insurance Number
3
F
M
year
month day
year
month day
F
M
year month day
7. Information about the child
Retraite Québec LPF-800A (2019-11)
In some cases, we require proof concerning the child (refer to page iii of the Information section). Indicate only the child or
children for whom you are requesting Family Allowance payments.
Sex Family name Given name
His or her mother’s family name at birth (last name only) Date of birth
Place of birth If the child returned to or arrived in Québec, indicate
the date he or she arrived:
What is your relationship to the child? Father Mother Other. Specify:
Is your spouse the child’s biological or adoptive parent? Yes No
Are you responsible for the care and education of this child? Yes No
Indicate which of the following situations applies to the child:
a)
a change of custody, shared custody or retained custody following the breakdown of your union. You must also
complete the Information on Child Custody form.
b)
an arrival in or return to Québec. The child has been living with you full-time since
year month day
.
c)
a baby born in Québec and the child has been living with you full-time since birth.
d)
an adoption. The child has been living with you full-time since
year month day
.
e) a child placed by a youth centre. Name of the youth centre:
Date on which you began paying the financial contribution:
year month day
.
f)
a child who was placed by a youth centre. The child returned home on
year month day
Other child
Sex Family name Given name
His or her mother’s family name at birth (last name only) Date of birth
Place of birth If the child returned to or arrived in Québec, indicate
the date he or she arrived:
What is your relationship to the child? Father Mother Other. Specify:
Is your spouse the child’s biological or adoptive parent? Yes No
Are you responsible for the care and education of this child? Yes No
Indicate which of the following situations applies to the child:
a)
a change of custody, shared custody or retained custody following the breakdown of your union. You must also complete
the Information on Child Custody form.
b)
an arrival in or return to Québec. The child has been living with you full-time since
year month day
.
c)
a baby born in Québec and the child has been living with you full-time since birth.
d)
an adoption. The child has been living with you full-time since
year month day
.
e) a child placed by a youth centre. Name of the youth centre:
Date on which you began paying the financial contribution:
year month day
.
f)
a child who was placed by a youth centre. The child returned home on
year month day
If you are registering more than two children, please provide the necessary information on a separate sheet. Be sure
to Give your Social Insurance Number, sign the sheet and send it to us with this form.
Give your Social Insurance Number
year month day
4
8. Application for direct deposit
Retraite Québec LPF-800A (2019-11)
To ensure that your application is processed as quickly as possible, make sure that you have:
fully completed all sections of the form;
indicated your Social Insurance Number where necessary;
signed the form;
attached the required proof if applicable.
If you checked “Change in custody” or “Shared custody” in section 1, you must also complete the Information on
Child Custody form.
Family Allowance payments will be deposited in an account in your name at a Canadian financial institution.
Name of the financial institution
Address
(number, street, apartment)
City Province Postal code
Branch number
(transit number)
Number of the
bank or caisse
Account number
(folio)
The account must be in your name or that of the applicant,
if you are applying on his or her behalf. You can only sign up
for direct deposit if the deposit will be made in a Canadian
bank or caisse.
9. Declaration
Making a false declaration is an offence and may result in repercussions against you.
By sending this form, I declare that the information provided is complete and accurate.
If you have completed this form for another person, provide your personal information below.
Family name Given name
Signed in the capacity of
Telephone
area code
Other
area code
Extension
Send us this form and the required documents online at
www.retraitequebec.gouv.qc.ca.
Your application will be processed faster and the postal delay will be eliminated.
If you are unable to use the online service, please return the form and documents to:
Retraite Québec, Allocation famille, case postale 7777, Québec (Québec) G1K 7T4
Give your Social Insurance Number
year month day
F
M
Information on Child Custody
Family Allowance
1. Information about you
Give your Social Insurance Number
Please print.
2. Information regarding child custody
Retraite Québec LPF-831A (2019-11)
Sex Family name Given name
Date of birth Your mother’s family name at birth (last name only)
2.1 Select your situation from the choices below:
a)
You have obtained custody of a child
OR
b) You have retained custody of a child after the breakdown of your union AND have never received Family Allowance
payments in your name.
If you checked a) or b), provide the given names of each of the children who live with you more than 60% of the time
a month AND for whom you are not already receiving the payment.
Child’s given name Date of birth
Date the change
came into effect
year month day year month day
c)
You have obtained shared custody
We consider that custody of a child is shared when the child lives 40% to 60% of the time with each parent
on a monthly basis. Provide the given names of each of the children affected by the change in the following table.
Given name Date of birth
Your custody
time (%)
Other parent’s
custody time
(%)
Date shared
custody began
year
month day
year
month day
(Examples: 40% = 3 days a week, 50% = every second week, 60% = 4 days a week)
If there has been a change in custody or shared custody, you must complete this form and enclose it with your Application
for Family Allowance Payments.
0255831 LX
year month day
Telephone Other Extension
area code area code
You must provide us with information on the other person who is currently entitled to Family Allowance payments.
3. Information about the person who is currently receiving Family Allowance payments
2. Information regarding child custody (continued)
4. Declaration and signatures (mandatory)
Retraite Québec LPF-831A (2019-11)
2.2 If necessary, describe your monthly custody time. When do the children arrive and when do they leave?
Note: Use a separate sheet if needed.
Making a false declaration is an offence and may result in repercussions against you.
Signature of the other person who is presently entitled to Family Allowance payments and who was identified in section 3.
Signature Date
year month day
If you cannot obtain the signature from the other person, explain why.
If you are unable to obtain the signature, we will have to carry out verifications, which will increase the time it takes to process
your application.
I declare that all the information given in this application is true and complete.
Your signature Date
year month day
Family name Given name Date of birth
Address (number, street, apartment)
City Province Country Postal code
What is the relationship between this person and each child (father, mother, other)?
Give your Social Insurance Number
Telephone Other Extension
area code area code
4. Declaration and signatures (continued)
Online By telephone
Québec region: 418 643-3381
Montréal region: 514 864-3873
Toll-free: 1 800 667-9625
For more information
Retraite Québec LPF-831A (2019-11)
If you have completed this form for another person, provide your personal information below.
Family name Given name
Signed in the capacity of
Signature Date
year month day
Give your Social Insurance Number
In order to avoid processing delays, make sure:
you have completed all the sections of the form;
you have provided your Social Insurance Number where required;
you have signed the form;
you enclose your Application for Family Allowance Payments with this form.
Send us this form and the required documents online at
www.retraitequebec.gouv.qc.ca.
Your application will be processed faster and the postal delay will be eliminated.
If you are unable to use the online service, please return the form and required documents to the following address:
Retraite Québec, case postale 7777, Québec (Québec) G1K 7T4
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Application for Family Allowance Payments (Qubec)

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Completed 16 August 2020

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