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.

Lifeline Discount
Is your mailing address the same as above?
Applicant must provide proof of eligibility for one of the following programs:
Select all that apply.

Maximum file size: 516MB

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.