Get Lifeline Allowance Form

Completing the Lifeline Allowance Form online is a straightforward process that can help you secure a reduced rate for your electricity if you use life-support equipment. This guide will walk you through each section of the form, ensuring that you provide the necessary information accurately.

Follow the steps to fill out the Lifeline Allowance Form online.

1. Press the ‘Get Form’ button to obtain the Lifeline Allowance Form and open it in your editor.
2. Begin by providing your personal information in the designated fields. Include your full name, Social Security number, and driver's license number.
3. Indicate the relationship of the patient to you and confirm their full name. Ensure this information is accurate for processing.
4. List all life-support equipment that you or the patient uses regularly. Refer to the provided list of qualifying medical devices. If your equipment is not listed, write its name and explain why it should qualify.
5. If applicable, provide details about your backup power system, including how long it will last during an outage.
6. Once you have completed your section, ensure the physician fills out their section with their verification of the patient's medical condition and necessary equipment.
7. Review the entire form for accuracy before saving your changes. If needed, print out a copy for your records.
8. Finally, submit the completed form by mailing it to the Anaheim Public Utilities Department at the specified mailing address.

Complete your Lifeline Allowance Form online today to ensure you receive the support you need.