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Forms

Apply for benefits

The following documents are intended to help you complete your application for benefits. Consult them to know in advance the questions asked when you apply online or over the phone.

Unofficial documents - Do not mail

* A person who, as a rule, receives nearly the same gross salary for each pay period. E.g., a public service employee, or a grocery clerk, whose hours don't vary or vary very little, etc.

** A person whose earnings vary between pay periods. E.g., employee receiving tips, on commission, on call, etc.

Employment information—Relevé de renseignements sur l’emploi RQAP form (French only)

If you are a salaried worker whose income is not insurable under Employment Insurance but is insurable under the QPIP, your employer must fill out this form and you must then send it to us.

By mail

Your employer must complete this Employment information (PDF file., 365 KB, French only) and you must mail it to us at the following address:
Centre de service à la clientèle
19, rue Perreault Ouest, 1er étage
Rouyn-Noranda (Québec) J9X 0A1

Federal and Québec income tax withheld on benefits

Source Deductions Return—Use this Revenu Québec form to determine the additional amount to be withheld from your Québec Parental Insurance Plan (QPIP) benefits for Québec income tax purposes. The completed and signed form must be mailed to the QPIP’s Centre de service à la clientèle.

2013 Personal Tax Credits Return—Use this Canada Revenue Agency form to determine the additional amount to be withheld from your Québec Parental Insurance Plan (QPIP) benefits for Federal income tax purposes. The completed and signed form must be mailed to the QPIP’s Centre de service à la clientèle.

Other useful forms

Power of Attorney—This Ministère de l'Emploi et de la Solidarité sociale form may be completed by a person who wishes to appoint someone else to act on his or her behalf in dealings with the Québec Parental Insurance Plan (QPIP). The completed and signed form must be mailed to the QPIP’s Centre de service à la clientèle.

Permission to Disclose Personal Information to a Third Party—This Ministère de l’Emploi et de la Solidarité sociale form must be completed in order to authorize the QPIP to disclose personal information to someone designated by the beneficiary or his or her representative. The completed and signed form must be mailed to the QPIP’s Centre de service à la clientèle.

Application for review form

If you wish to contest a decision rendered concerning your file, you must complete an application for review form and send it to us within 90 days following receipt of the decision notice.

Your application for review will be assessed on the basis of the facts available at the time the decision was rendered. You must notify us of any change in your situation that occurs after that time.

For additional information : The Review Process (folder Fichier PDF., 227 Ko).

For quicker processing, use our online services.

By mail

Acrobat prints documents in letter format (8½ inches X 11 inches) by default. Since the Application for review form (PDF file., 84 KB) is a legal-size document (8½ inches X 14 inches or 215 mm by 355 mm), you must adjust the desired printing format and use legal-size paper.

Please send the completed and signed form to the following address:

Centre de service à la clientèle
19, rue Perreault Ouest, 1er étage
Rouyn-Noranda (Québec) J9X 0A1

By Internet

Access your online file, select the “Application(s) for review” tab, enter the information concerning your application for review and submit it.

Complaint form

If you are dissatisfied with our service or if you disagree with a decision we have rendered:

By telephone

Call the Centre de service à la clientèle at the following numbers:

  • Throughout North America, toll free: 1 888 610-7727
  • Overseas: 1 416 342-3059*
    * Charges apply.

You can also file a complaint by calling the Direction des plaintes et des relations avec les citoyens of the Ministère de l’Emploi et de la Solidarité sociale at 1-866-644-2251.

By mail

Acrobat prints documents in letter format (8½ inches X 11 inches) by default. Since the Complaint form (PDF file., 41 KB) is a legal-size document (8½ inches X 14 inches or 215 mm by 355 mm), you must adjust the desired printing format and use legal-size paper.

Please send the completed and signed form to the following addresses:

Centre de service à la clientèle
19, rue Perreault Ouest, 1er étage
Rouyn-Noranda (Québec) J9X 0A1

Direction des plaintes et des relations avec les citoyens
Ministère de l’Emploi et de la Solidarité sociale
425, rue Saint-Amable, bureau RC.175
Québec (Québec)  G1R 4Z1

By Internet

Access your online file, select the “Service requests” tab, draft your complaint and submit it.

Last update: 2013-10-16