Paper Applications

Below is the application for those who are choosing to mail their Lifeline application. However, to speed things up, you can also enroll online!

If you are a resident in Oregon or Texas please download your state-specific application below. If you are a California resident you must Enroll online or with an agent.

What You Need to Enroll for
Lifeline Cell Phone Service:

Along with your application, send a copy of:

1) Your government issued photo ID or driver’s license.

2) An Eligibility Document.

IMPORTANT

  • – Documents must be dated within 12 months of application date.
  • – Must be your documents.
  • – Must show your name or your dependent’s name.
  • – Your name and address must match your state-issued photo ID, or your application will be turned down.

 

HOUSEHOLD WORKSHEET (IEH FORM)

Household Worksheet
Download English | Download Spanish

Oregon Household Worksheet
Download English | Download Spanish

Oregon Tribal Household Worksheet
Download English | Download Spanish

Your privacy is important to us.

You will be able to submit these documents as part of your application. Rest easy because your documents are always 100% protected under our Privacy Policy.

Click on your state to print a paper application to send in.

All NLAD states may enroll by mail using this application.

NLAD opt-out states – California*, Oregon, and Texas please use the links below.

*Service providers in California with broadband-only subscribers must use NLAD to enroll these subscribers.

HAVE YOU APPLIED THROUGH THE NATIONAL VERIFIER AND BEEN APPROVED AS ELIGIBLE?
If not, please go to the National Verifier at LifelineSupport.org for eligibility approval. You must submit your National Verifier application ID with your paper application prior to mailing.

SNAP / Food Stamps / CalFresh

Program Approval Letter, Benefit Statement, or Verification of Coverage Letter, should contain the following basic information:

  • Name of the program,
  • Name of the beneficiary,
  • Eligibility dates, OR
  • Current participation status

OR

Eligibility Screenshot or printout from an online portal or website tool, should contain the following basic information:

  • Name of the program or state equivalent,
  • Name of the beneficiary,
  • Case number,
  • Eligibility dates, OR
  • Current participation status

Medicaid / Medi-Cal

Program Approval Letter, Benefit Statement, or Verification of Coverage Letter, should contain the following basic information:

  • Name of the program or state equivalent,
  • Name of the beneficiary,
  • Address of the beneficiary, and
  • Date of the award

OR

Eligibility Screenshot or printout from an online portal or website tool, should contain the following basic information:

  • Name of the program or state equivalent,
  • Name of the beneficiary
  • Medical Identification number, OR
  • Case number,
  • Eligibility dates, OR
  • Current participation status

Supplemental Security Income (SSI)

Approval Letter or Benefit Statement issued by the SSA, or on SSA letterhead.

  • Consumer’s name
  • Date
  • Eligibility Date
  • Claim number OR Other consumer identification number
  • Payment amount

Federal Public Housing Assistance (FPHA)

FPHA award letter, should contain the following basic information:

  • Name of the program,
  • Date of the award,
  • Name of the beneficiary, and
  • Award amount.

Federal Veterans Affairs (VA) Veterans & Survivors Pension Benefit

Pension Grant Letter, should contain the following basic information:

  • Participant’s name
  • Address
  • A decision about the participant’s monthly entitlement amount
  • Payment start date

Qualify by income and provide one of the following as proof.

  • Prior Year’s State, Federal or Tribal Tax Return
  • Unemployment/Workers' Compensation Benefits Statement
  • Divorce Decree or Child Support Documents
  • Veterans Administration Benefits Statement
  • Current Income Statement from Employer or Paycheck Stubs
  • Retirement/Pension Benefits Statement
  • Social Security Benefits Statement

Medi-Cal / Medicaid

Program Approval Letter, Benefit Statement, or Verification of Coverage Letter, should contain the following basic information:

  • Name of the program or state equivalent,
  • Name of the beneficiary,
  • Address of the beneficiary, and
  • Date of the award

OR

Eligibility Screenshot or printout from an online portal or website tool, should contain the following basic information:

  • Name of the program or state equivalent,
  • Name of the beneficiary
  • Medical Identification number, OR
  • Case number,
  • Eligibility dates, OR
  • Current participation status

CalFresh / Food Stamps / SNAP

Program Approval Letter, Benefit Statement, or Verification of Coverage Letter, should contain the following basic information:

  • Name of the program,
  • Name of the beneficiary,
  • Eligibility dates, OR
  • Current participation status

OR

Eligibility Screenshot or printout from an online portal or website tool, should contain the following basic information:

  • Name of the program or state equivalent,
  • Name of the beneficiary,
  • Case number,
  • Eligibility dates, OR
  • Current participation status

Lifeline Program

Due to sharing many of the same eligibility requirements those currently enrolled in the lifeline program may qualify for The Affordable Connectivity Program (ACP) also.

 

Food Distribution Program on Indian Reservations (FDPIR)

Notice of Action (award letter) acknowledging eligibility for FDPIR benefits;

  • Name of the beneficiary;
  • The beginning and ending dates of the award or certification period; and
  • The telephone number of the Food Distribution Program office, and the name and address of the person to contact for additional information.

OR

FDPIR participation documents(e.g., a benefit card or copy of a benefit card);

  • Name of the beneficiary
  • The beginning and ending dates of the award or certification period; and
  • The telephone number of the Food Distribution Program office, and the name and address of the person to contact for additional information.

Tribally-Administered Temporary Assistance to Needy Families (TANF)

TANF Award letter, should contain the following basic information:

  • Name of the program,
  • Name of the beneficiary
  • Address of the beneficiary
  • Date of the award

Tribal Head Start

Head Start Award letter, should contain the following basic information:

  • Name of the program,
  • Name of the beneficiary
  • Address of the beneficiary
  • Date of the award

Bureau of Indian Affairs General Assistance (BIA)

BIA Award letter, should contain the following basic information:

  • Name of the program,
  • Name of the beneficiary
  • Address of the beneficiary
  • Date of the award