Lifeline program annual recertification form 2026

1. Click ‘Get Form’ to open the Lifeline Program Annual Recertification Form in the editor.
2. Begin with Section 1: Subscriber Information. Fill in your first name, last name, last four digits of your SSN, and date of birth. Ensure you provide your primary residence address accurately, including street address, city, state, and zip code.
3. In Section 2: Eligibility for Lifeline, indicate if you or a household member receives benefits from qualifying federal programs. Check all applicable programs such as SNAP or Medicaid. If qualifying through income, refer to the chart provided and enter your household size and total income.
4. Proceed to Section 3: Required Certifications. Carefully read each statement and provide your initials where required to certify that all information is true and correct. This section ensures compliance with Lifeline Program requirements.
5. Finally, sign and date the form at the bottom before mailing it to HTC's Lifeline Administrator at the specified address.

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