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Click ‘Get Form’ to open it in the editor.
Begin by entering your full legal name in capital letters as required. Ensure that this matches your official documents.
Provide your phone number and email address for communication purposes. This is recommended for faster processing.
Select an identity verification method. You can choose to enter the last four digits of your Social Security number, a Tribal ID, or another form of government ID.
Fill in your home address accurately, avoiding P.O. Boxes. If applicable, indicate if you live on Tribal lands.
Complete the qualification section by checking all relevant government assistance programs you participate in or provide income details as necessary.
Initial each agreement statement on page 7 to confirm your understanding and compliance with the program rules before signing and dating the form.
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Feb 17, 2021 For annual reports, indicate by check mark the information filed with this Form: ☒ Annual Information Form ☒ Audited Annual Financial Statements.Read more
The Affordable Connectivity Program is an FCC benefit program that helps ensure that households can afford the broadband they need for work, school, healthcareRead more
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