Lifeline Program Application Form - Telephone Company Name: Smithville Tel Co. - Required Documentation

Sep 19, 2026

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Lifeline Program application cover instructions for requesting Lifeline-supported telephone and internet services from Smithville Tel Co. specify required information on a newly accompanied application form, including eligibility verification, personal and address information, dependent household documentation, proof of qualification, and signature with date. Applicants must attach a copy of their most recent telephone/internet bill and include service type selection: voice only, broadband internet only, or bundled service, plus mailing of all required forms and supporting documents to the Lifeline Administrator.

LanguageEnglish

CategoryForms

FormatPDF

Pages9

Reading Time3 min

AccessFree to download

Required sections on the new application form

Verify eligibility and complete Sections 2 and 3

Complete Section 4 and attach supporting bill copy

Select Lifeline service type

Complete the household worksheet and mail documents

LIFELINE PROGRAM Application Form Telephone Company Name: Smithville Tel Co. Telephone Company ID: 0818 Legal First and Last Name: Mailing address 1: City, State, and Zip: Telephone Number: The Federal Lifeline Program rules require that all individuals requesting for a Lifeline supported service provide the following on the NEW accompanied application form: I. Please verify your eligibility: 1. Complete Section 2 – Personal Information 2. Complete Section 2 (continued)– Address Verification 3. Complete Section 2 (continued)– If you are applying through a child or a dependent in your household. 4. Complete Section 3 – Proof of Qualification 5. Complete Section 4 – Initial, sign and date the form 6. Attach a copy of your most recent telephone / internet bill REQUIRED: Applying for Lifeline on: Service Type (Check One) Voice Only Broadband Internet Only Bundled-Voice and Broadband Internet Please note, section 5 is currently not applicable. II. Complete the attached household worksheet Mail this cover letter along with the NEWLY enclosed Lifeline application form, the Lifeline household worksheet, your most recent telephone/internet bill, and supporting documents to the address listed below: Lifeline Administrator 30 Lanidex Plaza West PO Box 685 Parsippany, NJ 07054-0685 Should you have any questions or need assistance, you may call (888) 785-3696. Thank you and we look forward to assisting you in obtaining Lifeline benefits. Sincerely, Lifeline Administrator ^ _`abcdefgh if j h klmnolpn lq r mnsntrounpnmlv vwrv oxyntq vwnzxpvwo{|xqv xm}wxpnxtl pvntpnv qnt~l|n 􀁿 􀂀􀂁􀂂3􀂃 􀂄g􀂅bc􀂆c􀂇if g􀂅􀂈 􀂅bc􀂉􀂊bc􀂋h􀂊bi􀂌 􀂍􀂇j􀂎hd ef gh if j hgb􀂉􀂏􀂊bj hb􀂉fj dh􀂉j hd 􀂋h􀂉􀂐f􀂍h􀂈 ac d j bd abd􀂊 _􀂑 􀂒m{x􀂓􀂔nv klmnolpnmxt}wxpnqnt~l|n􀂈 􀂅bc􀂍􀂇j􀂎hdd􀂊hahj hgfdgb􀂉bj h􀂕ba fih􀂏􀂊bj hb􀂉bj h 􀂊b􀂕h 􀂏􀂊bj h􀂈 ac d j bd abd􀂊 _ 􀂑 􀂒m{x􀂓􀂔nv klmnolp nmxtl pvntp nv qnt~l|n􀂈 􀂅bc􀂍􀂇j􀂎hdd􀂊hahj hgfdgb􀂉􀂅bc􀂉􀂕ba fih􀂏􀂊bj hb􀂉􀂅bc􀂉􀂊b􀂕h 􀂍bj j h􀂍df bj 􀂈 ac d j bd abd􀂊 _ 􀂑 􀂒m{x􀂓􀂔nv klmnolpnmx tu􀂓psons}wxpnr ps lpvntpnv qnt~l|n􀂖 􀂅bc􀂍􀂇j􀂎hdd􀂊hahj hgfdgb􀂉􀂅bc􀂉􀂕bafih 􀂏􀂊bj ha cj􀂌ih􀂌 􀂋h􀂉􀂐f􀂍hb􀂉􀂅bc􀂉􀂊b􀂕h a cj􀂌ih􀂌 􀂋h􀂉􀂐f􀂍h􀂈 ac d j bd abd􀂊 _ 􀂗bc􀂉􀂊bc􀂋h􀂊bi􀂌 􀂍􀂇jjbd 􀂎hd efgh if j hg􀂉b􀂕􀂕b􀂉hd􀂊􀂇jbj h􀂏􀂊bj hb􀂉fj dh􀂉j hd 􀂍b􀂕􀂏􀂇j􀂅 _ 􀂗bc􀂇􀂉hb ji􀂅􀂇iib􀂘h􀂌 db 􀂎hd bj he fghi fj ha hj hgfd 􀂏h􀂉􀂊bc􀂋h􀂊bi􀂌 􀂈 􀂙􀂚􀂛 􀂜􀂝􀂞􀂜􀂝􀂞􀂟􀂚􀂙 _ 􀂄g􀂕b􀂉hd􀂊􀂇jbj h 􀂏h􀂉􀂋bj fj 􀂅bc􀂉􀂊bc􀂋h􀂊bi􀂌 􀂎hd􀂋 ef gh if j h􀂈 􀂅bc􀂇􀂉h a􀂉h􀂇 fj􀂎d􀂊h¡¢¢ £􀂋􀂉cih􀂋􀂇j􀂌􀂘f iiib􀂋h 􀂅bc􀂉a hj hgfd_ ¤¥1¦ §􀂃 1 ¥5􀂁􀂃3¥5􀂂¨© `􀂊bc􀂋h􀂊bi􀂌 f􀂋􀂇􀂎􀂉bc􀂏bg􀂏hb􀂏ih􀂘􀂊bif􀂐h db􀂎hd􀂊h􀂉􀂇j􀂌􀂋􀂊􀂇􀂉hf j􀂍b􀂕h􀂇j􀂌hª􀂏hj􀂋h􀂋 «h􀂐hj f gd􀂊h􀂅 􀂇􀂉hj bd 􀂉hi􀂇dh􀂌 db h􀂇􀂍􀂊bd􀂊h􀂉¬_ 5®5¦ 2 §¯3 °5􀂁±²3®36§¦¦5 1®5¦¥3±³3±􀂃5® ef gh if j hf􀂋j bj´d􀂉􀂇j􀂋gh􀂉􀂇aih_ 􀂗bc􀂍􀂇jjbd 􀂎f􀂐h 􀂅bc􀂉ef gh if jha hj hgfddb􀂇j bd􀂊h􀂉􀂏h􀂉􀂋bj 􀂈 h􀂐hj f gd􀂊h􀂅􀂆c􀂇if g􀂅 _ µ3 ¥5®3􀂃¦ 5® ¦¥§􀂃65±¶ 􀂗bc􀂕c􀂋d􀂎f􀂐h􀂇􀂍􀂍c􀂉􀂇dh􀂇j􀂌d􀂉ch fj gb􀂉􀂕􀂇dfb jb jd􀂊f􀂋gb􀂉􀂕􀂇j􀂌bj􀂇ii efgh if j h´􀂉hi􀂇dh􀂌 gb􀂉􀂕􀂋b􀂉􀂆ch􀂋dfb jj􀂇f􀂉h􀂋 _ 􀂄g 􀂅bc􀂎f􀂐h g􀂇i􀂋hb􀂉g􀂉􀂇c􀂌cihjdf j gb􀂉􀂕􀂇df bj 􀂈 􀂅bc􀂘f iiib􀂋h 􀂅bc􀂉efgh if j hahj hgfd«f_h_ 􀂈 􀂌h´hj􀂉bii􀂕hjdb􀂉ahf j􀂎a􀂇􀂉􀂉h􀂌 g􀂉b􀂕d􀂊h􀂏􀂉b􀂎􀂉􀂇 􀂕¬ 􀂇j􀂌d􀂊h·jfdh􀂌 ¸d􀂇dh􀂋 􀂎b􀂐h􀂉j􀂕hjd􀂍􀂇jd􀂇hih􀂎􀂇i􀂇􀂍df bj􀂋􀂇􀂎􀂇fj􀂋d􀂅bc _ ¹􀂊f􀂋 􀂕􀂇􀂅fj􀂍ic􀂌h «acdf􀂋jbd if􀂕fdh􀂌 db¬gf j h􀂋b􀂉f􀂕􀂏􀂉f􀂋bj􀂕hjd_ º5􀂁 ¶1° ®33¨ ¦5􀂃¥5»5¦¥3±¨5¼􀂁¶3®¦􀂃 􀂗bc􀂘fi ij hh􀂌 db􀂋􀂊b􀂘 􀂅bc􀂉􀂏􀂊bj hb􀂉fjdh􀂉j hd 􀂍b􀂕􀂏􀂇j􀂅􀂇jb½f􀂍f􀂇i􀂌b􀂍c􀂕hjd g􀂉b􀂕bj hbgd􀂊h􀂎b􀂐h􀂉j􀂕hjd 􀂆c􀂇if g􀂅fj􀂎 􀂏􀂉b􀂎􀂉􀂇􀂕􀂋 b􀂉 􀂏􀂉b􀂐h 􀂅bc􀂉􀂇j jc􀂇if j􀂍b􀂕h_ ¾ih􀂇􀂋h􀂏􀂉b􀂐f􀂌h􀂍b􀂏fh􀂋 bg􀂅bc􀂉b½f􀂍f􀂇i 􀂌b􀂍c􀂕hj d􀂋􀂘fd􀂊 d􀂊f􀂋􀂇􀂏􀂏if􀂍􀂇df bj _ 􀂄j􀂍ic􀂌hd􀂊h􀂌b􀂍c􀂕hj d􀂋f jb􀂏df bj ^b􀂉b􀂏df bj ¿ ahib􀂘À Á Â􀂄g􀂅bc􀂆c􀂇ifg􀂅d􀂊􀂉bc􀂎􀂊􀂇􀂎b􀂐h􀂉j􀂕hj d􀂏􀂉b􀂎􀂉􀂇􀂕À􀂍b􀂏fh􀂋 bg􀂅bc􀂉􀂋d􀂇dh 􀂄Ã􀂍􀂇􀂉􀂌 􀂇j􀂌 􀂇jb½f􀂍f􀂇i􀂌b􀂍c􀂕hj d g􀂉b􀂕d􀂊h􀂏􀂉b􀂎􀂉􀂇􀂕􀂅bc􀂇􀂉h􀂆c􀂇ifg􀂅fj􀂎d􀂊􀂉bc􀂎􀂊 «􀂅bc􀂉¸Ä`¾ 􀂍􀂇􀂉􀂌 􀂈 Åh􀂌f􀂍􀂇f􀂌 􀂍􀂇􀂉􀂌 􀂈 ¸c􀂏􀂏ih􀂕hj d􀂇i ¸h􀂍c􀂉fd􀂅􀂄j􀂍b􀂕h «¸¸􀂄¬ahj hgfd ihddh􀂉􀂈 ¡h􀂌h􀂉􀂇i¾ca if􀂍Æbc􀂋fj􀂎`􀂋􀂋f􀂋d􀂇j􀂍h «¡¾Æ`¬􀂇 􀂘􀂇􀂉􀂌 ihddh􀂉􀂈 b􀂉 bd􀂊h􀂉􀂇􀂍􀂍h􀂏dh􀂌􀂌b􀂍c􀂕hjd􀂋¬_ Ç Â􀂄g􀂅bc􀂆c􀂇if g􀂅d􀂊􀂉bc􀂎􀂊 􀂅bc􀂉fj􀂍b􀂕hÀ􀂍b􀂏fh􀂋 bg􀂅bc􀂉􀂋d􀂇dh􀂄Ã􀂍􀂇􀂉􀂌􀂇j􀂌􀂅bc􀂉i􀂇􀂋d 􀂋d􀂇dh􀂈 gh􀂌h􀂉􀂇i 􀂈 b􀂉¹􀂉fa􀂇id􀂇ª􀂉hdc􀂉j 􀂈 􀂏􀂇􀂅􀂋dc a􀂋 gb􀂉È􀂍bj􀂋h􀂍cdf􀂐h􀂕bj d􀂊􀂋􀂈 b􀂉bd􀂊h􀂉􀂇􀂍􀂍h􀂏dh􀂌 􀂌b􀂍c􀂕hj d􀂋 _ Éf􀂋fd if gh if j h􀂋c􀂏􀂏b􀂉d_b􀂉􀂎db 􀂋hhd􀂊h gc ii if􀂋d bg􀂇􀂍􀂍h􀂏dh􀂌 􀂌b􀂍c􀂕hj d􀂋 _ Éf􀂋fd if

FAQs

What eligibility information must be completed on the new application form?

Complete Section 2 (Personal Information) and Section 2 (continued) for Address Verification. If applying through a child or dependent in the household, complete the relevant Section 2 (continued) portion as instructed.

What proof is required to submit with the application?

Attach a copy of the most recent telephone/internet bill and include supporting documents as required by the Lifeline Administrator mailing instructions.

How do applicants choose the Lifeline service type?

Check one service type: Voice Only, Broadband Internet Only, or Bundled-Voice and Broadband Internet. Section 5 is noted as not applicable.

Sep 19, 2026

Upload by Stanley