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.

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

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 Pension and Survivors 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