The Commission is making the following changes under the Paperwork Reduction Act (PRA) to the Lifeline Program Application Form (FCC Form 5629) and Lifeline Program Annual Recertification Form (FCC Form 5630). We are also requesting PRA approval for the collection of an additional piece of electronic data to be collected via the Lifeline National Verifier portal, specifically the consumer portal which enables individuals to verify eligibility to receive Lifeline Program benefits. The changes are itemized below.
The existing forms are located on the USAC website for reference: Lifeline Program Application Form and the Lifeline Program Recertification Form.
ELECTRONIC COLLECTION OF AN ALTERNATE EMAIL ADDRESS
Change Description: Add a field to the National Verifier consumer portal called “Alternate Email Address” accompanied by some instructional language.
Field Name: Alternate Email Address
New Language to Accompany Field: By entering an alternate email address in this field, you are representing that the person whose email address is provided is aware that they are being added as a secondary contact for your account, and you are consenting that a copy of any communications sent to your primary email address will also be sent to this secondary email. The alternate email address should not belong to a service provider representative. Examples of a secondary contact person are a caseworker or family member.
LIFELINE PROGRAM APPLICATION FORM (FCC FORM 5629) CHANGES
CHANGE #1
Change Description: Update the instructions in Section 1 regarding the types of documents a consumer can provide.
Location: Section 1 under “You may need to show other documents”
New Language:
You may need to show other documents
If the Lifeline Program Administrator is not able to validate that you or someone in your household qualify using this form and electronic databases, you may need to provide an official document from one of the government qualifying programs or documentation that proves your annual income. You can submit copies of your official documents with this application or wait until the Lifeline Program Administrator asks you for them. To add them now, include the documents in option 1 or option 2 below:
If you qualify through a government program, provide a copy of a document such as an approval letter or benefit letter with name of the person in your household who qualifies, name of the program, and issue date within the past 12 months or future expiration date.
If you qualify through your income, provide a copy of the prior year’s state, federal, or Tribal tax return or a current income statement from an employer or paycheck stub for 3 consecutive months (or other accepted documents).
Visit lifelinesupport.org to see all acceptable document guidelines.
CHANGE #2
Change Description: Replace the fifth certification with new language.
Location: Section 4, fifth certification (I agree that my service provider can give the Lifeline Program administrator all of the information I am giving on this form. I understand that this information is meant to help run the Lifeline Program and that if I do not let them give it to the Administrator, I will not be able to get Lifeline benefits.)
New Language: I agree that all of the information I provide on this form may be collected, used, shared, and retained for the purposes of applying for and /or receiving the Lifeline Program benefit. If the laws of my state or Tribal government require it, I agree that the state or Tribal government may share information about my benefits for a qualifying program with the Lifeline Program administrator. The information shared by the state or Tribal government will be used only to help find out if I can get a Lifeline Program benefit. I understand that this information is meant to help run the Lifeline Program and that if it is not provided to the Administrator, I will not be able to get Lifeline benefits.
CHANGE #3
Change Description: Move and modify the statement related to consent for text messages from Section 4 to Section 2.
Reason for the Change: We want to allow the subscriber to opt into text messages if they would like to.
Location: Section 2 after the “What is the best way to reach you?” boxes.
New Language: If I selected the phone or text option, I consent to let USAC contact me at my Lifeline phone number for important reminders and updates to my Lifeline service. If I selected the text message option, message and data rates may apply. Text STOP to end messages.
LIFELINE PROGRAM RECERTIFICATION FORM (FCC FORM 5630) CHANGES
CHANGE #1
Change Description: Add a notice to Section 1 of the form stating that the subscriber may need to provide documents.
Location: Section 1 of the form, underneath the “Be Honest on the Form” language.
Language:
You may need to show other documents
If the Lifeline Program Administrator is not able to validate that you or someone in your household qualify using this form and electronic databases, you may need to provide an official document from one of the government qualifying programs or documentation that proves your annual income. The Lifeline Administrator will contact you with instructions if documents are required.
CHANGE #2
Change Description: Replace the fifth certification with new language.
Location: Section 4, fifth certification (I agree that my service provider can give the Lifeline Program administrator all of the information I am giving on this form. I understand that this information is meant to help run the Lifeline Program and that if I do not let them give it to the Administrator, I will not be able to get Lifeline benefits.)
Language: I agree that all of the information I provide on this form may be collected, used, shared, and retained for the purposes of applying for and /or receiving the Lifeline Program benefit. If the laws of my state or Tribal government require it, I agree that the state or Tribal government may share information about my benefits for a qualifying program with the Lifeline Program administrator. The information shared by the state or Tribal government will be used only to help find out if I can get a Lifeline Program benefit. I understand that this information is meant to help run the Lifeline Program and that if it is not provided to the Administrator, I will not be able to get Lifeline benefits.
CHANGE #3
Change Description: Move and modify the statement related to consent for text messages from Section 4 to Section 2.
Location: Section 2 after the “What is the best way to reach you?” boxes.
Language: If I selected the phone or text option, I consent to let USAC contact me at my Lifeline phone number for important reminders and updates to my Lifeline service. If I selected the text message option, message and data rates may apply. Text STOP to end messages.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Melissa Holo |
| File Modified | 0000-00-00 |
| File Created | 2021-01-12 |