Information about the Lifeline consumer forms is also available on the Universal Lifeline Consumer Forms page and the State Eligibility Verification Processes page.

To view and download the forms, visit the Lifeline Program Forms page.

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The Basics: Universal Consumer Forms

Q1: What do I need to do?

A1: Find out if the new universal forms are required in your state (they are required for most states). If they are, begin using the forms for all new Lifeline consumers by July 1, 2018, and for all annual recertifications with 60-day notice periods that start July 1 or later.

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Q2: What's changing, and what will remain the same?

A2: The biggest change is that Lifeline service providers need to use either the new, official FCC consumer forms, or a state-mandated form. Lifeline forms created by service providers or third-party vendors are no longer allowed.

As always, service providers will remain responsible for processing applications and verifying whether the consumer is eligible for Lifeline. Service providers still need to keep a copy of the completed Lifeline forms in their records for the required record retention period.

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Q3: What is the final version of the form? Will there be any more changes?

A3: The final version of the forms was posted to the Lifeline Program Forms page on May 15, 2018. There will be no more changes to the form this year.

The next time the forms will change will be in early 2019, when the federal poverty guidelines are updated.

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Q4: What if my company doesn't use the new forms?

A4: If your company is selected for an audit, and the auditors discover that you are using non-compliant (old) forms and/or did not use the new forms by the deadline, your company could be subject to repayments to the Lifeline Program and other potential enforcement actions.

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Q5: The forms say to sign in black ink. What if they use a different color ink?

A5: Black ink is preferred because it helps automated scanner process the forms faster. Please encourage your customers to use blank ink, especially for USAC-elected recertification forms and forms in National Verifier states! However, blank ink is not required; USAC will accept forms where the applicant uses a different ink color.

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July 1 Implementation Deadline

Q6: Do we have to wait until July 1? Or can we start using the forms earlier?

A6: You don't have to wait! Service providers can start using all of the new forms immediately.

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Q7: Do we need to obtain a new application form (FCC Form 5629) for all subscribers prior to July 1? Or just any new subscriber?

A7: Only new subscribers. You do not need to collect new application forms from existing customers.

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Q8: Is it correct that for recertification, we need to begin using the recertification form for the July 2018 anniversary group?

A8: No. The deadline is not based on the anniversary date. It is based on when the 60-day response period begins.

So no matter when the subscriber's anniversary date is, you need to use the new forms for any recertification notice (the first day of the 60-day response period) that starts on July 1 or later.

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Q9: How does this change the annual recertification process?

A9: The annual recertification process is not changing. Service providers who handle annual recertification efforts will continue to do so. The only difference is that you need to use the new, official FCC Form 5630 — Lifeline Annual Recertification Form — for your annual recertification process.

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State-Mandated Forms and Requirements

Q10: If the state has a Lifeline form, should we keep using it post-July 1?

A10: It depends. Visit the State Eligibility Verification Processes page to see which form to use in your state, or speak with your state directly.

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Q11: Who do we contact to see if our state requires its own form?

A11: Visit the State Eligibility Verification Processes page to see which form to use in your state, or speak with your state telecommunications regulator directly.

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Q12: Do states with a Lifeline program administrator need to use the FCC's universal Lifeline consumer forms?

A12: Not necessarily. It is up to the state whether to continue using their state-mandated form or switch to the FCC's universal forms. Visit the State Eligibility Verification Processes page to see which form your state decided to use.

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Q13: What should we do if a state-mandated form includes different information than the Lifeline eligibility form?

A13: If a state requires service providers to use their eligibility form, service providers should use that form. USAC will accept all state-mandated eligibility forms.

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Q14: Can you provide an example of state-specific questions that can be added to the FCC forms?

A14: An example is that in Massachusetts, wireless ETCs are required to include the MA DTC's contact information on their application forms. To meet this requirement, wireless ETCs can add the information on a separate page to the universal forms. To find out if there are any state-specific requirements in your state, speak with your state telecommunications regulator directly.

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Changes and Modifications Allowed

Q15: Can we add our logo, company name, and contact information on the form?

A15: You cannot add a logo to the form itself. However, you can add your company's name and address to the yellow "Apply" box at the bottom of the first page. You can also create a company-specific cover page with your logo and contact information.

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Q16: Can we decrease the spacing and font to fit the form on fewer pages?

A16: No. You cannot change the format or layout of the paper form.

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Q17: Can we add a bar code?

A17: Yes. You can overlay the bar code (or bar code area) on the form, as long as it does not cover up any of the existing information.

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Online Forms and IVR

Q19: Are we allowed to create an online version of the form?

A19: Yes, you can build an online version of the form. However, do not change the language that is used on the FCC's universal consumer forms, and do not re-order the sections of the form on the formal record of the certifications.

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Q20: Can we accept applications over the phone using the new universal forms?

A20: Yes. The process for how service providers accept and process Lifeline applications is not changing. The only thing that's changing is the form you are required to use. Make sure your agents read prompts based on the new universal consumer forms, and read each certification statement.

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Q21: Can you provide guidance on translating the recertification form into an Interactive Voice Response form that can be completed over the phone?

A21: During the recertification, the IVR must use the language from the paper forms. The IVR must read each certification statement, and obtain affirmative response after each individual certification statement.

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Q23: Are we required to meet Federal e-signature requirements for the initialed certification statement?

A23: Yes. For USAC to accept e-signatures, the e-signature must be in line with the federal e-Signature rules.

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Application Form (FCC Form 5629)

Q24: On the universal application form, there is a Section 5 that asks for agent information. Who is the agent (a customer service rep, guardian, customer)? Is all information required, and if so, what is the Agent ID number that should be used?

A24: The "Agent" is a customer service representative, or sales agent representing the service provider.

No, the information is not required at this time. In the future, USAC will start collecting and tracking information about "Agents" who help Lifeline consumers apply. At that time, the Agent ID numbers will be assigned and this section will be required. Until then, this section is not required.

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Q26: When an existing Lifeline customer switches from phone to internet credits, do they fill out the entire form again?

A26: No. The service provider is permitted to change their service type without obtaining a new Lifeline application form. USAC recommends obtaining consent before changing a Lifeline subscriber's service offering.

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Recertification Form (FCC Form 5630)

Q28: The universal Recertification Form does not contain a section for Beneficiary. Some states require the company to see proof on recertification. Shouldn't this section be present?

A28: The form is designed to comply with the federal recertification rules. If the state requires you to collect beneficiary information, you can collect it on an additional page attached to the form.

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Q29: If USAC performs the annual recertifications for our subscribers, are we required to use the new recertification forms?

A29: Yes, you are still required to use the new forms. But for recertification, if you use USAC-elected recertification, USAC will take care of that for you.

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Household Worksheet

Q31: Is there ever an occasion when the Household worksheet is not required? If it is always required, could the forms be combined so the privacy language is only printed once?

A31: Yes, there are occasions when the household worksheet isn't required (for example, if the person lives in a single-family home). The Household Worksheet is only required if more than one "economic household" resides at the same address.

No, we cannot combine the forms or omit the privacy language from the household worksheet. The consumer needs to complete both (unmodified) forms.

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