Florida Public Service Commission
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Lifeline Florida On-line Application for Recipients of Medicaid, Supplemental Nutrition Assistance Program (SNAP)/Food Stamps, or Temporary Cash Assistance (TCA)



Section 364.107(1), Florida Statutes provides that personal identifying information concerning a participant in a telecommunications carrier's Lifeline Assistance Plan held by the Public Service Commission is confidential.

Lifeline is a federal benefit. Willfully making false statements to obtain the benefit can result in fines, imprisonment, de-enrollment or being barred from the program.

Only one Lifeline service is available per household. A household is defined, for purposes of the Lifeline program, 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 limitation constitutes a violation of the Lifeline rules and will result in the subscriber’s de-enrollment from the program. Lifeline is a non-transferable benefit and the subscriber may not transfer his or her benefit to any other person.

Customers of AT&T Florida, CenturyLink, Verizon, SafeLink Wireless, Assurance Wireless, or T-Mobile Wireless who are not currently receiving benefits from one of the listed programs, may be able to qualify for Lifeline service using income criteria. Those customers may demonstrate their income eligibility for Lifeline service to the Florida Office of Public Counsel. Please contact the Florida Office of Public Counsel at 1-800-540-7039. Customers of other telephone companies who are not currently receiving benefits from one of the listed programs, should contact their telephone company to determine if they meet the income eligibility criteria necessary to participate in Lifeline.

Applicants wishing to qualify for Lifeline using Supplemental Security Income (SSI), Federal Public Housing Assistance (Section 8), Low-Income Home Energy Assistance Program (LIHEAP), National School Lunch Free Lunch Program, or Bureau of Indian Affairs Programs (Tribal Temporary Assistance for Needy Families, Head Start Subsidy, NSLP) can complete a hard-copy Lifeline application (available on the PSC Web site), and submit it to their telephone provider along with verification that they are currently participating in one of these programs.

Contact Information
The residential address listed on this application is:
* Last 4 digits of Social Security Number
    The last four digits of your Social Security Number are required to complete this application. If you do not wish to provide this information here, please apply for Lifeline directly through your Service Provider.
Service Provider
I hereby certify that I participate in the following public assistance program(s):  

I certify, that:

I will notify my Lifeline provider within 30 days if I no longer participate in a qualifying DCF assistance program, if I receive more than one Lifeline benefit, or if another member of my household is receiving a Lifeline benefit;

If I move to a new address, I will provide that new address to my Lifeline provider within 30 days;

If I provided a temporary residential address in this application, I will be required to verify my temporary residential address every 90 days with my Lifeline provider;

My household will receive only one Lifeline service and, to the best of my knowledge, my household is not already receiving a Lifeline service;

The information contained in this application is true and correct to the best of my knowledge;

I acknowledge that providing false or fraudulent information to receive Lifeline benefits is punishable by law; and,

I acknowledge that I may be required by my Lifeline provider to recertify my continued eligibility for Lifeline at any time, and my failure to re-certify as to my continued eligibility will result in deenrollment and the termination of my Lifeline benefits.

I understand that my name, telephone number, and address may be provided to the Universal Service Administrative Company (USAC) (the administrator of the program) and/or its agents for the purpose of verifying that my household does not receive more than one Lifeline benefit.

I agree to allow exchange of any necessary information between the local telephone company, the appropriate federal or state agency, or fund administrator, to verify my eligibility to participate in the Lifeline discount program. I give this permission on the condition that the information in this form and any information about my participation in the above public assistance programs provided by officials be maintained as confidential customer account information.

I agree to these terms and conditions:

Rule 25-4.0665, F.A.C. Form PSC/RAD 158 (REV 06/10)

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