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Click ‘Get Form’ to open the household worksheet in the editor.
Begin by entering your Applicant Name and Client ID # at the top of the form. This information is crucial for identification purposes.
Fill in your Street Address, City, State, and Zip Code to ensure accurate processing of your application.
Indicate that you are the head of household and provide the date when your household last received any income.
Complete the section regarding your last employer by providing their name, phone number, and the date of your last paycheck.
Answer whether you have applied for Unemployment Insurance and if you have received public assistance in the last 30 days by selecting 'Yes' or 'No'.
In the Basic Needs table, document how each need (Shelter, Food, Utility) has been met over the past 30 days. Be specific about any assistance received.
Add any additional comments if necessary and ensure to sign and date at the bottom before submission.
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Lifeline Program Application (FCC FORM 5629) Instructions. Page 1: About the Lifeline Program. Lifeline is a federal government program of the Federal Communications Commission (FCC) that provides a monthly phone or internet service discount for qualifying low-income consumers.
What is a household in Lifeline?
A household is a group of people who live together and share income and expenses (even if they are not related to each other). Complete the Lifeline household worksheet to determine if more than one qualifying household is located at your address.
Which scenario is not eligible to receive multiple lifeline benefits?
If more than one person in your household participates in Lifeline, you are breaking the FCCs rules and will lose your benefit. Examples of one household: A married couple who live together are one household. They must share one Lifeline benefit.
Is ACP one per household?
You are only allowed to get one ACP benefit per household, not per person.
Is the Lifeline program legit?
California LifeLine was established by the Commission in compliance with the Moore Universal Telephone Service, Public Utilities Code 871 providing discounted basic residential (landline) telephone services to low-income households.
ohep household worksheet
Household worksheet form pdfOhep household worksheet formLifeline application form onlineLifeline National Verifier application FormCalifornia LifeLine application form pdfLifeline program application formUniversal formsLifeline Recertification Form
People also ask
What is the FCC form 5629?
FCC FORM 5629 OMB APPROVAL EDITION 3060-0819 Lifeline Program Application Form About Lifeline Lifeline is a federal benefit that lowers the monthly cost of phone or internet service. Rules If you qualify your household can get Lifeline for phone or internet service but not both.
household worksheet printable
DHS-FIA-807-OHEP-Household Worksheet
Instructions: If no one in your household has received any income in the last 30 days, the Applicant must complete and sign this form.
List every employer even if the employer did not issue an IRS W-2 form. If more space is needed, attach a separate page with your name and SSN at the top.
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