To view and download the forms, visit the Lifeline Program Forms page.
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.
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.
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.
A6: You don't have to wait! Service providers can start using all of the new forms immediately.
A7: Only new subscribers. You do not need to collect new application forms from existing customers.
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.
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.
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.
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.
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.
A16: No. You cannot change the format or layout of the paper form.
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.
A18: You can create a separate form or attachment for the customer service representative to add this information.
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.
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.
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.
A22: No. It is sufficient to ask the applicant if they live on federally-recognized Tribal lands.
A23: Yes. For USAC to accept e-signatures, the e-signature must be in line with the federal e-Signature rules.
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.
A25: When the consumer fills out a new application form, that application form is considered sufficient proof of consent for a transfer.
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.
A27: The applicant only needs to write in the total number of household members in the provided box, and check "Yes" or "No". The applicant does not need to provide the calculations on the form (there is not a space for this).
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.
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.
A30: Yes, it is part of the form, and service providers need to keep all 3 pages of the Household Worksheet.
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.