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NY Application for Verizon Lifeline Service free printable template
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Application for Verizon Lifeline Service New York Discounted Telephone Service PLEASE READ CAREFULLY USE PEN PRINT AND FILL OUT COMPLETELY Billing Telephone Number including area code Billing Name On Home Telephone Account last first Home Address number street apartment number if applicable middle initial city or town state zip code Please indicate below if the home address listed above is your permanent or temporary address Permanent Temporary Billing Address if different from Home Address P...PROGRAM PARTICIPATION AND CERTIFICATION I certify under penalty of perjury that I or a member of my household meet the income-based or program-based eligibility criteria for receiving the Lifeline discount. I certify my household will receive only one Lifeline service and to the best of my knowledge my household is not already receiving a Lifeline service. Your name telephone number address and information contained in this application as well as information associated with your Lifeline service...may be provided to the Universal Service Administrative Company USAC - administrator of the Lifeline discount program and/or its agents for the purpose of verifying your household does not receive more than one Lifeline benefit. You will be denied Lifeline benefits if you fail to provide Verizon with consent to provide the specified information to USAC. I acknowledge and consent that Verizon may provide my name telephone number address and information contained in this application as well as...information associated with your Lifeline service to the Universal Service Administrative Company USAC and/or its agents for the purpose of verifying that I or another member of my household does not receive more than one Lifeline benefit. Your prior year s state federal or Tribal tax return current income statement from an employer paycheck stub a Social Security statement of benefits a Veterans Administration statement of benefits a retirement or pension statement of benefits an Unemployment...or Workmen s Compensation statement of benefits federal or Tribal notice letter of participation in General Assistance a divorce decree a child support award other official document containing income information. PLEASE SIGN AND DATE THIS APPLICATION FORM AND PROVIDE PROGRAM BENEFICIARY NAME Billing Name Signature Date Name of Household Member Receiving Benefits or Self Relationship of Household Member Receiving Benefits to the Account Billing Name or Self PLEASE FAX OR MAIL SIGNED APPLICATION...AND PROOF OF ELIGIBILITY TO Fax Number 877-307-0991 Or mail to Verizon Lifeline Services PO Box 33075 St. Petersburg FL 33733-8075 If you have any questions please call 1 800 VERIZON. I agree not to transfer my Lifeline discount benefit to another person. I agree to notify Verizon within 30 calendar days if I move to another address and to provide the new address. No longer receive benefits from the federal or state program that qualified me for the Lifeline discount program. Annual household...income exceeds the Federal Poverty amount listed on page 3 that qualified me for the Lifeline discount Receives more than one Lifeline benefit or another member of my household is receiving a Lifeline service. in de-enrollment and termination of my Lifeline benefits. I agree to participate in the certification of my continued eligibility in the Lifeline discount program. The information contained in this application form is true and correct to the best of my knowledge. I or a member of my...household receive benefits from the following program check only one program Medicaid Supplemental Security Income SSI Low Income Home Energy Assistance Program Safety Net Assistance Section 8 Federal Public Housing Assistance National School Lunch Program Eligibility based on income see page 3 Temporary Assistance for Needy Families SNAP Supplemental Nutrition Assistance Program formerly known as Food Stamps Family Assistance Veteran s Disability Pension non-service related Veteran s...Surviving Spouse non-service related Bureau of Indian Affairs BIA General Assistance Head Start Tribal Land residents only Food Distribution Program Tribal Land residents only Along with this application please attach or fax a photocopy do not send an original of one of the following your current or prior year s statement of benefits from a qualifying state federal or Tribal program or a notice letter of participation in a qualifying state federal or Tribal program a program participation...document for example benefit card an official document indicating your participation in a qualifying state federal or Tribal program. Page 1 of 4 PLEASE READ AND CERTIFY THE FOLLOWING PROGRAM RULES The Lifeline discount program is a federal benefit and willfully making false statements to obtain this benefit can result in fines imprisonment de-enrollment or being barred from the program. Verizon is required by the Federal Communications Commission or FCC to verify your eligibility to participate...in the Lifeline discount program. Under penalty of perjury you must certify the following statements are true to the best of your knowledge. Please indicate your acknowledgement of each statement by a checkmark. Only one Lifeline discount is allowed per household consisting of either wireline or wireless service. A household is not permitted to receive Lifeline benefits from multiple providers. Violation of the one-per-household requirement constitutes a violation of Federal Communications...Commission rules and will result in your de-enrollment from the program and potentially prosecution by the United States government.
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How to fill out an NY application for Verizon form
Understanding the Verizon Lifeline Program
The Verizon Lifeline program is designed to provide essential telecommunications services to low-income households. This program offers discounts on phone or broadband services, making communication more accessible. It is crucial to understand the application process, especially when using the New York application form.
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The Lifeline program aims to ensure that all individuals have access to essential communication services.
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To qualify, applicants must meet specific income guidelines or participation in certain public assistance programs.
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Eligible households can receive discounts on monthly service costs, which can help reduce their overall expenses.
How do fill out the Verizon Lifeline application?
The application process involves several steps to correctly fill out the Verizon Lifeline application. Being prepared with the necessary information in advance simplifies the experience.
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Gather details such as the billing name and telephone number. Ensure accuracy to avoid processing delays.
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Indicate whether the address is permanent or temporary, as this affects eligibility.
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If your billing address differs from your permanent address, make sure to specify that to avoid confusion.
What are the program participation and certification instructions?
To participate in the Lifeline program, applicants must confirm their eligibility through various programs, such as Medicaid or Supplemental Security Income (SSI). Additionally, understanding the certification process is vital.
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Check if you qualify through other assistance programs, which can expedite the application process.
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Applicants must certify that all information is true under penalty of perjury; therefore, accuracy is imperative.
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Prepare to document any program participation clearly and concisely to meet Verizon's requirements.
What is the document submission process?
Submitting the right documents is key to a successful application. Ensure that you follow the guidelines carefully to avoid any rejection.
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Attach necessary documents that prove eligibility, such as income statements or proof of participation in assistance programs.
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Make sure to send clear photocopies; originals are not usually accepted. Check the specific requirements to avoid issues.
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Use a secure method for sending documents, and keep copies for your records to ensure transparency.
What are common issues and how can resolve them?
While applying, applicants may encounter specific pitfalls or challenges. Understanding common issues can help mitigate frustrations.
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Common issues include incomplete applications or missing documentation, leading to processing delays.
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If errors are discovered, promptly contact customer support to correct them, ensuring your application is reprocessed smoothly.
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Stay proactive about following up on your application status as this can help you address issues swiftly.
How can navigate support and resources?
Accessing the right support and resources can ease the process of applying for the Lifeline program. pdfFiller provides several features to assist users.
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Utilize pdfFiller to manage your documents, edit forms, and eSign securely online.
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Contact customer service for help with any questions or issues regarding the application process.
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Connect with local organizations that offer guidance and support for applicants of the Lifeline program.
What are my rights and responsibilities?
Understanding your rights when applying for the Lifeline program is essential. Consumers must be aware of their protections and responsibilities.
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All applicants have the right to understand the application process and be treated fairly.
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If issues arise, there are processes in place to file complaints and seek resolution effectively.
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Stay informed about any changes to the Lifeline program, ensuring compliance and continued eligibility.
Frequently Asked Questions about new york verizon lifeline form
What documents do I need to apply for the Verizon Lifeline program?
You will need proof of identity, income verification, and any documentation that confirms your participation in governmental assistance programs. It's important to have clear copies to expedite the process.
How long does it take to process the Lifeline application?
Typically, the processing time can take from a few days to a couple of weeks. Following up on your application status can help you get updates faster.
What should I do if my application is rejected?
If your application is rejected, carefully review the reasons provided. You can often correct the issues and reapply or appeal the decision with appropriate documentation.
Can I apply for the Lifeline program online?
Yes, you can apply for the Verizon Lifeline program online, which simplifies the process significantly. Ensure you have all required information available for a smooth application.
Is there a cost associated with applying for the Lifeline program?
There is no fee to apply for the Lifeline program. Make sure to avoid any third-party services that charge for the application process, as this should be free.
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People Also Ask about application verizon lifeline online
What is lifeline in NJ?
Lifeline is a federal program that provides eligible low-income individuals with a free smartphone and free wireless phone service (free data, free monthly minutes and unlimited texting).
Which Lifeline provider uses Verizon?
We're dedicated to continuing TracFone's participation in the Lifeline program. Verizon offers Lifeline plans for home phone service, wireless and Fios Home Internet. TracFone offers Lifeline services on prepaid cell phones and service provided by SafeLink Wireless® and Walmart Family Mobile.
Does Verizon have a disability discount?
Directory Assistance Charges will be waived for any Customer presubscribed to the Discounted Plan for Disabled Customers. Each call is billed in one (1) minute increments after an initial minimum call duration of one (1) minute. Any partial minute is rounded up to a full minute.
Do lifeline and ACP work together?
Can I receive both the ACP and Lifeline benefits at the same time? Yes. You can also combine these benefits with other state and local benefits where available. They can be applied to the same qualifying service or separately to a Lifeline service and an ACP service with the same or different providers.
What does ACP mean on Lifeline?
The Affordable Connectivity Program provides a monthly discount for internet service up to $30 per eligible household, or up to $75 per eligible household on Tribal lands.
What is the difference between lifeline and ACP?
ACP has a broader eligibility criterion than the Lifeline program, allowing a household to receive the benefit if at least one member is at or below 200 percent of the federal poverty guidelines, participates in similar support programs, received a federal Pell Grant during the current year, or otherwise meets the
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