[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-306512-105":53,"doc-detail-306512-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","lifeline-assistance-program-illinois-certification-form-enrollment-certification","LIFELINE ASSISTANCE PROGRAM - Illinois Certification Form - Enrollment & Certification","","Enrollment and certification form for the SafeLink Lifeline Assistance Program in Illinois. Collects applicant and verifier personal details, address history, contact information, and plan selection among 68, 125, or 250 minutes with text allowances and call features. Requires selecting one qualifying public assistance program and provides guidance on which programs need proof. Includes applicant attestations under penalty of perjury, authorization for record verification, eligibility recertification, one-per-household compliance, and instructions to return the application by mail or fax.",{"@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/lifeline-assistance-program-illinois-certification-form-enrollment-certification/306512/",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/lifeline-assistance-program-illinois-certification-form-enrollment-certification/306512.png","ImageObject",442,249,{"name":88,"@type":89},"Fez","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",8,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What personal information does Section 1 collect for the SafeLink Lifeline enrollment?","Question",{"text":109,"@type":110},"Section 1 collects the name and physical residence address of the person verifying for assistance, plus contact phone number, email address, birthday, zip code, and mailing address. It also includes beneficiary/dependent details when applicable.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How do you choose a SafeLink plan in this form?",{"text":114,"@type":110},"Section 1 requires checking one plan option: 68, 125, or 250 free nationwide text allowances (up to 1250 texts). The plan descriptions specify call features, roaming, and how unused minutes are handled or carried over.",{"name":116,"@type":107,"acceptedAnswer":117},"What does the applicant certify and authorize in Section 3?",{"text":118,"@type":110},"Section 3 requires checks, signing, and dating, with attestations that the applicant participates in a qualifying program and will notify SafeLink within 30 days of changes affecting eligibility. It also authorizes SafeLink to access records, confirm continued eligibility, and share information with USAC and/or social service agencies for verification.","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},306512,1790341660,{"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":76,"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":9},2336478940794,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","LIFELINE ASSISTANCE PROGRAM  \nEnrollment ID:    \nILLINOIS CERTIFICATION FORM  \nSection 1 Date:    \nPlease make sure that you provide correct personal information. Your information will be validated against Public Records and any discrepancies could result in delays in your approval or rejection of service.  \n1. PLEASE PRINT name and physical residence address of person verifying for assistance:  \nLast Name First Name Middle Initial Last 4 digits of SSN  \nStreet Address / Apt. Number (no PO BOX allowed)  \nCheck here if your  \nCity  \naddress is temporary  \nAddress Line 2 State  \nContact Phone Number  \nEmail Address  \nBirthday  \nZip Code  \nMailing Address  \nMailing Address (PO BOX allowed) Mailing Address 2 City Zip Code State  \nComplete this part ONLY if your child or dependent is the beneficiary of the qualifying program.  \nFirst Name Last Name Birth Date (MM/DD/YYYY) Last 4 Digits of SSN  \n\n| Choose your plan (check one): 68 Free\u003Cbr>Nationwide Text\u003Cbr>(Up to 1250 texts) | 125 Free\u003Cbr>Nationwide Text\u003Cbr>(Up to 1250 texts) | 250 Free\u003Cbr>Nationwide Text\u003Cbr>(Up to 1250 texts) |\n| --- | --- | --- |\n| All programs feature Local Calls, National Long Distance, Voicemail, Nationwide Text, Roaming at no Additional Cost, Free 911, 411 Directory Assistance at no Additional Cost. The 68 minutes plan includes 100+ International Long Distance Destinations. The 68 and 125 minutes plans feature carry-over minutes from month to month. You can send or receive up to 1250 texts per month with any plan. The 250 minutes plan will not carry-over the minutes on your next monthly minutes delivery. However, if you redeem additional minutes cards, all unused minutes will carry-over for three consecutive months. |  |  |\n\nSection 2  \nI hereby certify that I participate in at least ONE of the following public assistance programs (select just ONE program):  \nSupplemental Nutrition Assistance Program (SNAP) Food Stamps (*) Temporary Assistance for Needy Families (TANF) (*)  \nSupplemental Security Income (SSI)  \nFederal Public Housing Assistance (Section 8)  \nLow-Income Home Energy Assistance Program (LIHEAP)  \nNational School Lunch Program's (free lunch program)  \nMedicaid (*)  \nNote: Programs with (*) DO NOT require proof of participation, these programs are validated by a state agency for your convenience. Remaining programs require you to provide proof of participation such as, an award letter from SSA or state agency stating that you receive the benefit, or a similar official document. All documents must have the same name and address as provided in this application. Provide Copies ONLY  \nSafeLink is a Lifeline supported service. Lifeline is a federal benefit, and only eligible subscribers may enroll. Customers 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. Lifeline is available for only one line per household. A household is defined as any individual or group of individuals who live together at the same address and share income and expenses. A household is not permitted to receive Lifeline benefits from multiple providers. Violation of the one-per-household rule constitutes a violation of FCC rules, and will result in the Customer's deenrollment from Lifeline. Lifeline is a non-transferable benefit, and a Customer may not transfer his or her benefit to  \nanother person.  \nPromo Code:  \nSection 3  \nYou MUST place a check mark ( ) next to each statement, then Sign and Date below (your application cannot be approved without these items) .  \nI certify under penalty of perjury to each of the following:  \n1. I participate in the above designated qualifying program.  \n2. I understand that I must notify SafeLink within 30 days if I no longer participate in the qualifying program, if I or another member of my household obtains Lifeline supported service from another carrier, or, for any other reason, I no longer qualify for Lifeline support.  \n3. I understand I may be r","cbCaidu6h6PyKHAn","https://ap.wps.com/l/cbCaidu6h6PyKHAn","pdf",200126,"English","# Enrollment ID\n# Section 1: Personal Information & Plan Choice\n## Choose your plan (68/125/250)\n# Section 2: Qualifying Public Assistance Program\n## Participation statement and proof requirements\n# Section 3: Certification, Authorization & Signature","[{\"question\":\"What personal information does Section 1 collect for the SafeLink Lifeline enrollment?\",\"answer\":\"Section 1 collects the name and physical residence address of the person verifying for assistance, plus contact phone number, email address, birthday, zip code, and mailing address. It also includes beneficiary/dependent details when applicable.\"},{\"question\":\"How do you choose a SafeLink plan in this form?\",\"answer\":\"Section 1 requires checking one plan option: 68, 125, or 250 free nationwide text allowances (up to 1250 texts). The plan descriptions specify call features, roaming, and how unused minutes are handled or carried over.\"},{\"question\":\"What does the applicant certify and authorize in Section 3?\",\"answer\":\"Section 3 requires checks, signing, and dating, with attestations that the applicant participates in a qualifying program and will notify SafeLink within 30 days of changes affecting eligibility. It also authorizes SafeLink to access records, confirm continued eligibility, and share information with USAC and/or social service agencies for verification.\"}]","LIFELINE ASSISTANCE PROGRAM - Illinois Certification Form - Enrollment & Certification | PDF",1789837293]