FCC FORM 5629 Lifeline Program Application Form - Fill and-2026

1. Click ‘Get Form’ to open the FCC FORM 5629 in the editor.
2. 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.
3. Continue to Section 2b to enter your home address. If applicable, provide a mailing address that differs from your home address.
4. If applying through a child or dependent, complete Section 2c with their details including full legal name and date of birth.
5. In Section 3, indicate how you qualify for Lifeline by checking the appropriate government programs or providing income details as required.
6. Review the agreement statements in Section 4. Initial each statement to confirm your understanding and compliance before signing at the bottom of the page.
7. Finally, submit the completed form by mailing it to the provided address or follow any additional instructions given on our platform for submission.

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