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Collects applicant identity, residential and mailing address, contact details, birth date, and Social Security or Tribal ID information. Requires proof of participation in qualifying federal, state, or tribal assistance programs, or proof of income, and explains prepaid activation and usage rules for maintaining eligibility. Includes disclosures on one benefit per household, program limits, eligibility verification, and potential service and emergency coverage limitations.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/california-application-information-lifeline-program-application/306652/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/california-application-information-lifeline-program-application/306652.png","ImageObject",442,249,{"name":88,"@type":89},"Anda","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",9,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information is required from the applicant on the California Lifeline application?","Question",{"text":109,"@type":110},"The form requests first and last name, residential and mailing address, contact phone and email, date of birth, and Social Security (last 4 digits) or full Tribal ID number, along with eligibility details for the qualifying program or income proof.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"Which qualifying programs can support eligibility for Lifeline benefits?",{"text":114,"@type":110},"The form lists multiple qualifying programs, including Federal Public Housing Assistance (Section 8), Medicaid/Medi-Cal, SNAP/CalFresh, SSI, Veterans or Survivors Pension, LIHEAP, WIC, NSL, TANF, CalWORKs/StanWORKs, WTW, GAIN, and several tribal or reservation-based options.",{"name":116,"@type":107,"acceptedAnswer":117},"How must Lifeline service be activated and kept active?",{"text":118,"@type":110},"Activation requires dialing 611 from an Access Wireless handset. The form states the service must be used at least once during any 30-day period through eligible actions such as calls, texts, data use, purchasing minutes/data, or responding to Access Wireless confirmation; otherwise eligibility may be suspended after 30 days (with a 15-day cure period).","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},306652,1791372030,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":47,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":73},962075006959,"https://ap-avatar.wpscdn.com/avatar/e0002397efbe92a78e?_k=1776741047341049297","CALIFORNIA  \nAPPLICATION INFORMATION  \nFirst Name:   MI:   Last Name:    \nResidential Address:   Apt/Floor/Other:  (NO P. O. BOXES, MUST BE YOUR PRINCIPAL ADDRESS)  \nCity:   State:   ZIP Code:    \nThis address is:  Permanent  Temporary  Multi-Household I am a Tribal Resident:  Yes  No  \nMailing Address:   Apt/Floor/Other:   City:   State:   ZIP Code:   Contact Phone \\#:   Email Address:   Date of Birth:   Last 4-digits of Social Security Number (or full Tribal ID Number):    \nQUALIFYING PROGRAM INFORMATION  \nApplicant must provide proof of participation in an eligible program below or proof of income*, as well as proof of identificaion and address.  \n Federal Public Housing Assistance (FPHA)/Section 8  \n Medicaid/Medi-Cal  \n Supplemental Nutrition Assistance Program (SNAP)/Food Stamps/CalFresh  \n Supplemental Security Income (SSI)  \n Veterans or Survivors Pension Benefit  \n Low Income Home Energy Assistance Program (LIHEAP)  \n Women, Infants and Children Program (WIC)  \n National School Lunch Program (NSL)  \n Temporary Assistance for Needy Families (TANF)  \n California Work Opportunity and Responsibility to Kids (CalWORKs)  \n Stanislaus County Work Opportunity & Responsibility to Kids (StanWORKs)  \n Welfare-to-Work (WTW)  \n Greater Avenues for Independence (GAIN)  \n Tribal TANF  \n Bureau of Indian Affairs General Assistance  \n Head Start Income Eligible (Tribal Only)  \n Food Distribution Program on Indian Reservations  \n*[Go to](Go to www.accesswireless.com/ca for additional qualifying)[ www.accesswireless.com/ca](Go to www.accesswireless.com/ca for additional qualifying)[ for additional qualifying](Go to www.accesswireless.com/ca for additional qualifying) information.  \nApproved Lifeline subscribers receive a monthly allotment of  \nUnlimited Talk, Unlimited Text, and 2 GB of Data.  \nActivation and Usage Requirements  \nThis service is a prepaid service, and you must activate it by dialing 611 from your Access Wireless handset. To keep your account active, you must use your Lifeline service at least once during any 30-day period by completing an outbound call, sending a text message, using data, purchasing additional minutes or data from Access Wireless, answering an inbound call from someone other than Access Wireless, or by responding to a direct contact from Access Wireless confirming that you want to continue receiving Lifeline service from them. If your service goes unused for 30 days, you will no longer be eligible for Lifeline benefits and your service will be suspended (allowing only 911 calls and calls to the Access Wireless Customer Care center) subject to a 15-day cure period during which you may use the service (as described above) or contact Access Wireless to confirm that you want to continue receiving your Lifeline service from them.  \nImportant Information About the Lifeline Program  \nThis i-wireless LLC d/b/a Access Wireless offering is a California LifeLinesupported service. Only eligible consumers may enroll in the program and proof of eligibility is required for enrollment. This program is limited to one benefit per household, consisting of either wireline or wireless service. A household is defined, for the purposes of the LifeLine program, as any individual or group of individuals who live together at the same address and share income and expenses. LifeLine service is non-transferable. Violation of the one-perhousehold rule constitutes a violation of the FCC rules and will result in the customer’s de-enrollment from the LifeLine program. LifeLine is a governmentassistance program and consumers who willfully make false statements in order to obtain the benefit can be punished by fine or imprisonment, or can be barred from the program. Coverage limitations such as weather, terrain, signal strength, and/or service outages may affect wireless phone service, quality or access to E-911 and or 911 in the event of an emergency. By removing your wireless cellphone from a residence that does not have other phone se","cbCairAZOriKnYXs","https://ap.wps.com/l/cbCairAZOriKnYXs","pdf",143579,"English","# California Application Information\n## Residential and Mailing Address\n## Qualifying Program Information\n## Activation and Usage Requirements\n## Important Information About the Lifeline Program\n## Certification Statements","[{\"question\":\"What information is required from the applicant on the California Lifeline application?\",\"answer\":\"The form requests first and last name, residential and mailing address, contact phone and email, date of birth, and Social Security (last 4 digits) or full Tribal ID number, along with eligibility details for the qualifying program or income proof.\"},{\"question\":\"Which qualifying programs can support eligibility for Lifeline benefits?\",\"answer\":\"The form lists multiple qualifying programs, including Federal Public Housing Assistance (Section 8), Medicaid/Medi-Cal, SNAP/CalFresh, SSI, Veterans or Survivors Pension, LIHEAP, WIC, NSL, TANF, CalWORKs/StanWORKs, WTW, GAIN, and several tribal or reservation-based options.\"},{\"question\":\"How must Lifeline service be activated and kept active?\",\"answer\":\"Activation requires dialing 611 from an Access Wireless handset. The form states the service must be used at least once during any 30-day period through eligible actions such as calls, texts, data use, purchasing minutes/data, or responding to Access Wireless confirmation; otherwise eligibility may be suspended after 30 days (with a 15-day cure period).\"}]","CALIFORNIA APPLICATION INFORMATION - Lifeline Program Application | PDF",1789839305]