Follow the steps to complete your application online:

1. Press the ‘Get Form’ button to access the application and open it in the editor.
2. Provide your first name, middle initial, and last name in the designated fields.
3. Input the last four digits of your Social Security number.
4. Enter your contact telephone number and physical address (note that this must be your principal address; P.O. Boxes are not acceptable).
5. Indicate whether this is a temporary address by selecting 'Yes' or 'No'.
6. Fill in your street address, apartment or floor number if applicable, city, state, and ZIP code.
7. Enter your date of birth and email address.
8. Initial the box confirming that you participate in at least one of the specified programs for eligibility.
9. Indicate if your address is a multiple household address by selecting 'Yes' or 'No'.
10. Certify that your household income is at or below 135% of the Federal Poverty Guidelines by initialing the box provided.
11. If applicable, certify that you live on Tribal Lands and participate in the specified programs.
12. Provide documented proof of eligibility either through program participation or your income.
13. In the certification section, initial by each certification statement to acknowledge your understanding and agreement.
14. Sign and date the application at the bottom of the form.
15. After completing all sections, save your changes, and choose to download, print, or share the application as needed.

Complete your application online today to access Lifeline benefits.