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The form explains household eligibility rules, limits on benefits per household and per service type, and requirements to provide accurate information. It also describes possible requests for supporting documents if eligibility cannot be verified electronically, and includes sections for applicant identity, contact details, and eligibility-related information with submission instructions to USAC’s Lifeline Support Center.",{"@graph":63,"@context":118},[64,80,101],{"@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/fcc-form-5630-lifeline-program-annual-recertification-form-read-online-free/305497/",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/fcc-form-5630-lifeline-program-annual-recertification-form-read-online-free/305497.png","ImageObject",442,249,{"name":88,"@type":89},"Mimi","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-12","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":79},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is the Lifeline Program annual recertification form used for?","Question",{"text":108,"@type":109},"It is used to recertify eligibility for the Lifeline monthly phone or internet service discount. 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About Lifeline  \nLifeline is a Federal Communications Commission (FCC) program that provides a monthly phone or internet service discount for qualifying low-income consumers.  \nRules  \nIf you qualify, your household can receive a monthly Lifeline benefit of up to $9.25 to lower the costs of phone or internet service and up to $34.25 for qualifying households on Tribal lands.  \n• If you get Lifeline for phone service, you can get the benefit for one mobile phone or one home phone, but not both.  \n• If you get Lifeline for internet service, you can get the benefit for your mobile phone or your home connection, but not both.  \n• If you get Lifeline for bundled phone and internet service, you can get the benefit for your mobile phone bundled service or your home bundled service, but not both.  \nYour household cannot get Lifeline from more than one phone or internet company.  \nYou are only allowed to get one Lifeline benefit per household, not per person. If more than one person in your household gets Lifeline, you are breaking the FCC’s rules and will lose your benefit.  \nWhat is a household?  \nA household is a group of people who live together and share income and expenses (even if they are not related to each other) . Complete the Lifeline household worksheet to determine if more than one qualifying household is located at your address. If more than one person in your household participates in Lifeline, you are breaking the FCC’s rules and will lose your benefit.  \nDo not give your benefit to another person  \nLifeline is non-transferable. You cannot give your Lifeline benefit to another person, even if they qualify.  \nBe honest on this form  \nYou must give accurate and true information on this form and on all Lifeline-related forms or questionnaires. If you give false or fraudulent information, you will lose your Lifeline benefit  \n(i.e., de-enrollment or being barred from the program) and the United States government can take legal actions against you. This may include (but is not limited to) fines or imprisonment.  \nYou may need to show other documents  \nIf the Lifeline Program Administrator is not able to validate that you or someone in your household qualify by checking available electronic resources (including eligibility databases for the FCC’s government agency partners), you may need to provide additional documents. For example, you may need to provide an official document that proves your participation in a qualifying government assistance program, your income, or your identity. Please include copies of your proof documentation when you submit your application to speed up processing time.  \n\n| Recertify\u003Cbr>To recertify for a Lifeline benefit, fill out the required sections of this form, initial every agreement statement, and sign on page 5. You can [also recertify online at](also recertify online at LifelineSupport.org)[ LifelineSupport.org](also recertify online at LifelineSupport.org)[ ](also recertify online at LifelineSupport.org)[for fastest processing.](for fastest processing.) | Mail the form to this address:\u003Cbr>USAC\u003Cbr>Lifeline Support Center PO Box 1000\u003Cbr>Horseheads, NY 14845 |\n| --- | --- |\n\nPage 1 of 7 [Universal Service Administrative Company |](Universal Service Administrative Company | www.lifelinesupport.org)[ www.lifelinesupport.org](Universal Service Administrative Company | www.lifelinesupport.org)  \nNeed help? Call the Lifeline Support Center at 1-800-234-9473  \nApproval Edition: February 2026  \nFCC FORM 5630  \nLifeline Program  \nAnnual Recertification Form  \nOMB 3060-0819 Est. time per response: 45 minutes  \n2a.  \nYour Information  \nAll fields are required unless indicated. Use only CAPITALIZED LETTERS and black ink to fill out this form.  \nWhat is your full legal name?  \nThe name you use on official documents, like your Social Security Card or Stat","cbCaiczPycHt4lnt","https://ap.wps.com/l/cbCaiczPycHt4lnt","pdf",472769,9,7,"English","# About Lifeline\n## Rules\n## What is a household?\n## Do not give your benefit to another person\n## Be honest on this form\n## You may need to show other documents\n# Your Information\n## Your Information (continued)","[{\"question\":\"What is the Lifeline Program annual recertification form used for?\",\"answer\":\"It is used to recertify eligibility for the Lifeline monthly phone or internet service discount. Completing the required sections and signing where required helps confirm continued qualification for the benefit.\"},{\"question\":\"How many Lifeline benefits can a household receive?\",\"answer\":\"A household can receive only one Lifeline benefit, not per person. If more than one person in the household participates in Lifeline, the household is breaking FCC rules and will lose the benefit.\"},{\"question\":\"What types of proof documents might be required?\",\"answer\":\"If the Lifeline Program Administrator cannot verify eligibility electronically, additional documents may be requested. These may include official documents proving participation in qualifying assistance programs, income, or identity.\"}]","FCC Form 5630 - Lifeline Program Annual Recertification Form - read online free | PDF",1789825470]