FCC Form 5629 Lifeline Program Application-2026

The FCC Form 5629 is an application for the Lifeline Program, which offers monthly discounts on phone or internet services to eligible low-income consumers. The form outlines eligibility criteria, including participation in government assistance programs or meeting income thresholds. It emphasizes that only one benefit per household is allowed and that the program is non-transferable. Applicants must provide accurate information and may need to submit additional documentation to verify eligibility. The form also includes sections for personal information, qualification details, and agreements regarding the use of provided data.

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Click ‘Get Form’ to open the Lifeline Program Application Form in our editor.
Begin by filling out your personal information in Section 2a. Provide your full legal name, phone number, date of birth, email address, and the last four digits of your Social Security Number (SSN). Ensure you use capital letters and black ink.
Continue to Section 2b to provide your home address. If applicable, indicate if you live on Tribal lands and fill out your mailing address if it differs from your home address.
In Section 3, indicate how you qualify for Lifeline by checking the appropriate government assistance programs or providing income details. Attach any necessary documentation to support your application.
Review Section 4 carefully and initial each agreement statement to confirm your understanding and compliance with the program rules.
Finally, sign and date the form before submitting it through our platform for processing.

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Versions	Form popularity	Fillable & printable
2024	4.6 Satisfied (25 Votes)
2021	4.8 Satisfied (32 Votes)
2019	4.7 Satisfied (29 Votes)
2018	4.8 Satisfied (33 Votes)

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