Get Lifeline Program Annual Recertification Form - Universalservice

This guide provides a clear and supportive overview of how to complete the Lifeline Program Annual Recertification Form online, ensuring that you can maintain your benefits. Follow these steps carefully to recertify your eligibility efficiently.

Follow the steps to fill out your form accurately.

1. Click ‘Get Form’ button to access the Lifeline Program Annual Recertification Form and open it in your editor.
2. Begin with Section 1, Consumer Information. Provide your first name, last name, date of birth, and the last four digits of your Social Security Number. If you cannot provide your Social Security Number, enter your Tribal Identification Number. Make sure to supply a valid phone number and your physical service address.
3. In Section 2, Program Requirement – One Per Household, you must provide your initials to certify that you meet the requirement of one Lifeline Program-supported service per household.
4. Proceed to Section 3, Program Requirement – Eligibility. Indicate if you, your dependent, or a member of your household receives benefits from any of the listed programs. If applicable, check all relevant benefits and confirm if your household income meets the criteria.
5. In Section 4, Notification Obligations, initial each statement to confirm your understanding of the obligations to notify your service provider of any changes affecting your eligibility.
6. Finally, in Section 5, Certifications, read each statement carefully, initial to confirm your agreement, and provide your signature and date. This section confirms that all information provided is accurate to the best of your knowledge.
7. Once all steps are completed, review your form, make any necessary adjustments, and then save your changes. You may download, print, or share the form as needed.

Ensure you complete your Lifeline Program Annual Recertification Form online today to keep your benefits active.