Lifeline Program - Application Form - FCC Form 5629 - OMB Approval Edition 3060-0819

Sep 19, 2026

Application package for the Access Wireless Lifeline service, requesting completion of FCC Form 5629 to verify eligibility and enroll qualifying low-income consumers. The document explains the need for a National Verifier Approval Code obtained via Lifeline Support or the enclosed USAC application, then completion and submission of the Access Wireless application with required ID and proof of address. It outlines monthly benefit limits, household rules, non-transferability, honesty requirements, and possible additional documentation.

LanguageEnglish

CategoryLetters

FormatPDF

Pages12

Reading Time4 min

AccessFree to download

About Lifeline

Rules and household eligibility

Honesty and documentation requirements

Application steps

Obtain a National Verifier Approval Code

Complete and submit the Access Wireless application

Dear Customer, Thankyou foryour interest in enrolling in the Lifeline service provided by Access Wireless. Completion of this form is required. This form is used for the purpose of verifying your eligibility for and enrolling you in Lifeline and an eligible Access Wireless service plan and will not be used for any other purpose. Lifeline benefits are subject to verification of eligibility by Access Wireless and the National Verifier. For available rate plans and offerings, [please visit accesswireless.com](please visit accesswireless.com) . Please read through this letter entirely and follow the process below. 1. To enroll into the Lifeline Program, you must first obtain a National Verifier Approval Code. You may obtain this code by: a. Enrolling online at [https://www.lifelinesupport.org](https://www.lifelinesupport.org). b. Completing the enclosed FCC/Universal Service Administrative Co. Application and mailing that portion of the application to the address below (Do NOT send to Access Wireless): Lifeline Support Center P.O. Box 1000 Horseheads, NY 14845 NOTE: USAC may request additional documentation during the enrollment process. *A National Verifier Approval Code is required to process your Access Wireless application. 2. Once you have received your National Verifier application approval code, please complete the Access Wireless application for Lifeline and return it, along with copies of your Unexpired Driver’s License or State-Issued ID, and your current proof of Address to Access Wireless using one of the following methods: • Secure Link Upload your application securely at this link: [https://documents.accesswireless.com/filedrop/ProspectDocUpload](https://documents.accesswireless.com/filedrop/ProspectDocUpload) • Mail Access Wireless 1 Levee Way Suite 1122 Newport, KY 41071 Once Access Wireless receives your completed application and, if approved, your order will be delivered within 7- 10 business days. Upon receipt, you will need to complete the activation instructions included to begin using your Access Wireless service. If you have any questions, please visit [accesswireless.com](accesswireless.com) or contact our Customer Care team at 1-866-594-3644. Thank you for choosing Access Wireless FCC FORM 5629 Lifeline Program Application Form OMB APPROVAL EDITION 3060-0819 1. About Lifeline Lifeline is a Federal Communications Commission (FCC) program that provides a monthly phone or internet service discount for qualifying low-income consumers. Rules If 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. • If you get Lifeline for phone service, you can get the benefit for one mobile phone or one home phone, but not both. • If you get Lifeline for internet service, you can get the benefit for your mobile phone or your home connection, but not both. • 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. Your household cannot get Lifeline from more than one phone or internet company. You are only allowed to get one Lifeline benefit per household, not per person. What is a household? A 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. Do not give your benefit to another person Lifeline is non-transferable. You cannot give your Lifeline benefit to another person, even if they qualify. Be honest on this form You must give accurate and true information on this form and on all Life

FAQs

How do I obtain a National Verifier Approval Code for Lifeline enrollment?

You must obtain a code from the National Verifier, either by enrolling online at lifelinesupport.org or by completing the enclosed FCC/USAC application and mailing it to the listed Lifeline Support Center address.

What documents do I need to submit with the Access Wireless Lifeline application?

Submit the completed Access Wireless application and copies of your unexpired driver’s license or state-issued ID, plus current proof of address. Additional documents may be requested if eligibility cannot be validated electronically.

Can one person receive Lifeline benefits for multiple providers or multiple times?

Lifeline cannot be received from more than one phone or internet company, and you are allowed one Lifeline benefit per household, not per person. Lifeline is also non-transferable and cannot be given to another person.

Sep 19, 2026

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