Lifeline Discount Form

Lifeline is a federal program that provides free or low-cost phone or internet service to low-income households through a monthly service discount.

IDENTIFICATION

ELIGIBILITY

Select all that apply.

SIGNATURE

By signing, I confirm that this application has been prepared or examined by me. Under the pains and penalties or perjury, I declare that to the best of my knowledge and belief, it and all accompanying documents and statements are true, correct and complete.
Signature is required.
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