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California lifeline application form

California lifeline application form pdf 2025

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The document is a renewal form for the Federal Lifeline Program, which provides telephone discounts to eligible households. It outlines the steps for renewing discounts, including verifying personal information, confirming eligibility based on program or income criteria, and submitting the form online or by mail before the specified response date. The form also includes instructions for reporting errors and certifying eligibility.

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Click ‘Get Form’ to open the California Lifeline Application Form PDF in our editor.
Begin by verifying your personal information in Step 1. Ensure that your name, address, and phone number are accurate. If there are any mistakes, contact your phone company within 30 days for corrections.
In Step 2, confirm if your household is already receiving federal Lifeline discounts. If yes, proceed to the next step.
For Step 3, indicate if you or anyone in your household participates in any of the listed programs by filling in the corresponding bubbles completely with a blue or black pen.
If applicable, move to Step 4 to check if your household's total annual gross income meets the eligibility criteria. Fill in the number of people in your household and their total income.
Finally, sign and date the form at the bottom. Make sure to print your name clearly and provide any additional required information.

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Who qualifies for Lifeline assistance?

Based on Your Income You can get Lifeline if your income is 135% or less than the Federal Poverty Guidelines (see the table below). The guideline is based on your household size and state. The table below reflects 135% of the 2025 Federal Poverty Guidelines.

How to apply for the California Lifeline program?

To apply for California LifeLine you must call your home or cell phone company and state you qualify for the program via Program-Based OR Income-Based. Once you inform the home or cell phone company that you qualify, they will begin the application process for you.

Where to send a Lifeline application form?

USAC Lifeline Support Center PO Box 1000 Horseheads, NY 14845 Page 2 OMB APPROVAL EDITION 3060-0819 Lifeline Program Application Form Page 2 of 8 Universal Service Administrative Company | .lifelinesupport.org Need help? Call the Lifeline Support Center at 1-800-234-9473 FCC FORM 5629 What is your full legal name?

What is the maximum income to qualify for Lifeline?

If you qualify, your household can receive a monthly Lifeline benefit of up to $9.25 to lower the costs of phone or internet service and up to $34.25 for qualifying households on Tribal lands. If you get Lifeline for phone service, you can get the benefit for one mobile phone or one home phone, but not both.

How do I submit to Lifeline?

Methods to Apply for Lifeline: Online, Mail, or Through a Phone or Internet Company. You will need your full name, date of birth, last 4 digits of your Social Security Number or Tribal identification number, and home address.