A Public Notice has been released to provide guidance on the new universal forms for the Lifeline Programs that consumers and ETCs must use to verify and recertify subscriber eligibility beginning on July 1, 2018:

  • FCC Form 5629 – The Lifeline Program Application Form
  • FCC Form 5630 – The Lifeline Program Annual Recertification Form
  • FCC Form 5631 – The Lifeline Program Household Worksheet

These forms are intended for use in all states and territories, regardless of whether the National Verifier has been rolled out in that state or territory. If state law or regulations require ETCs to use a pre-existing universal enrollment or recertification form for Lifeline subscribers in that state, ETCs may continue to use those forms instead of the forms above. If a state or ETC requires additional information from Lifeline applicants beyond the information collected in the FCC’s universal Lifeline forms, the ETC may include additional questions in its online forms or include an attachment with paper copies of the FCC’s universal Lifeline forms.

The forms can be found here: http://www.usac.org/li/tools/forms/default.aspx. A Spanish language version of the form will also be made available on this site.

Please Contact Us if you have any questions.