FCC FORM 5629 Lifeline Program Application Form: Fill out & sign online

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Click ‘Get Form’ to open the FCC FORM 5629 in our platform.
Begin by filling out 'Your Information' section. Use capitalized letters and black ink. Provide your full legal name, phone number, date of birth, email address, and the last four digits of your Social Security Number (SSN). If you do not have an SSN, enter your Tribal Identification Number.
Next, complete your home address accurately. Ensure that you do not use a P.O. Box and indicate if you live on Tribal Lands.
If applying through a child or dependent, check the appropriate box and provide their full legal name, date of birth, and last four digits of their SSN.
In the 'Qualify for Lifeline' section, check all applicable government programs or indicate if qualifying through income. Follow the prompts to confirm household size and income eligibility.
Review the 'Agreement' section carefully. Initial next to each statement confirming your understanding and agreement before signing at the bottom of page 6.
Finally, submit your completed form by bringing or mailing it to the specified address provided in the instructions.

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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?

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.

What is the income to qualify for Lifeline?

You can qualify for Lifeline if your household income is up to 135% of the Federal Poverty Guidelines or if you or someone in your household participates in certain federal assistance programs like SNAP and Medicaid.

What is form 5629?

FCC Form 5629 is the application form for the FCCs Lifeline Program, which offers monthly phone or internet service discounts for qualifying low-income consumers. The form outlines rules, the definition of a household, application steps, and additional documentation requirements.

Is the federal lifeline program ending?

No, the Lifeline program is not ending. Despite concerns about government funding, Lifeline is still available. You can still apply for free or discounted cell phone service if you meet the income or program requirements.