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

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  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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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. FCC Form 5629: Lifeline Program Application Form PrintFriendly document fcc-form- PrintFriendly document fcc-form-
Lifeline is part of the Universal Service Fund. The Lifeline program is available to eligible low-income consumers in every state, territory, commonwealth, and on Tribal lands.
Do I 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.
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?
Qualifying survivors can receive a discount of up to $9.25 on phone, internet, or bundled services. After six months, they may apply for the standard Lifeline benefit of up to $9.25 for qualifying internet or bundled services or $5.25 per month for voice-only service.

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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. Get Started - Universal Service Administrative Company Lifeline Program get-started Lifeline Program get-started

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