Lifeline

Forms

ETCs are encouraged to file online.

FCC Form 481

File Online

FCC Form 481 Template

Carrier Annual Reporting Data Collection Form

FCC Form 481 Instructions

FCC Form 481 Upload Templates

FCC Form 497

For months December 2016 and later:
File Online
FCC Form 497
FCC Form 497 (editable)
FCC Form 497 bulk upload

For months November 2016 and prior:
2012 FCC Form 497
2012 FCC Form 497 (editable)

Notice: FCC Form 497 will be retired after the December 2017 data month (January 2018 snapshot).

Lifeline Worksheet

FCC Form 497 Instructions (updated 12/28/16)

FCC Form 497 Online Filing Instructions

Establishing User Entitlements

FCC Form 555 (For 2016 Recertification Data)

File Online

FCC Form 555

FCC Form 555 bulk upload

2016 Annual Lifeline Eligible Telecommunications Carrier Certification Form

FCC Form 555 Instructions

FCC Form 555 Online User Guide

Sample Consumer Forms

SAMPLE Lifeline Application Form

SAMPLE One-Per-Household Worksheet

SAMPLE Recertification Form

Sample application, household worksheet and recertification forms for non-National Verifier states.

National Verifier Forms

OFFICIAL National Verifier Application Form

OFFICIAL National Verifier One-Per-Household Worksheet

OFFICIAL National Verifier Recertification Form

The paper application, household worksheet, and recertification forms for use in National Verifier states (CO, MS, MT, NM, UT, WY)

Click here for Prior Year Forms