It will only take a few minutes to see if you qualify for a Lifeline cell phone from Assist Wireless.
Begin our simple online process. It will only take a few minutes to
see if you qualify for a phone from Assist Wireless.
Start by entering your Zip Code. This will let you know if you qualify for Lifeline cell phone service from Assist Wireless.
Please select a plan below.
Lifeline benefits are federal benefits and Applicants that make false statements in order to obtain the Lifeline
benefit can be punished by fine or imprisonment, de-enrollment or can be 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 may not receive
multiple Lifeline benefits from multiple providers. A violation of the one-per-household requirement constitutes
a violation of the Federal Communication Commissions rules and will result in de-enrollment from the program,
and could result in criminal prosecution by the United States government. The Lifeline benefit may be applied to
either one landline or one wireless number, but cannot be applied to both. Note that not all Lifeline services
are currently marketed under the name Lifeline.
I certify under penalty of perjury that I either participate in the indicated qualifying federal program or I
meet the income qualification to establish my eligibility for Lifeline. If required to do so, I have provided
accurate documentation of my eligibility. I certify I am head of the household, I am not listed as a dependent
on another person's tax return (unless over the age of 60) and the address listed is my primary residence. I
confirm local voice service discounts under the low income programs are limited to one per household and that my
household is receiving no more than one Lifeline supported service. If I am participating in another Lifeline
program at the time I apply for Assist Wireless Lifeline service, I agree to cancel that Lifeline service with
any other provider. I certify that I will only receive one Lifeline connection, will not have simultaneous or
multiple Lifeline discounts with another provider. I acknowledge that I may be required to re-certify my
continued eligibility for Lifeline at any time, and that failure to do so will result in the termination of the
Lifeline benefits. I understand that I must inform Assist Wireless within 30 days if I (1) no longer participate
in a federal qualifying program or programs or my annual household income exceeds 135% of the Federal Poverty
Guidelines; (2) I am receiving more than one Lifeline supported service per household; or (3) I, for any other
reason, no longer satisfy the criteria for receiving Lifeline support. I attest under penalty of perjury that I
understand this notification requirement, and that I may be subject to penalties if I fail to follow this rule.
I understand that Lifeline service is a non-transferable benefit, and that I may not transfer my service to any
other individual, including another eligible low-income consumer. I acknowledge and consent to the use of my
name, telephone number, and address to be given to the Universal Service Administrative Company (USAC) (the
administrator of the program) and/or its agents for the purpose of verifying that I 'm not receiving more than
one Lifeline benefit. I understand that refusal to grant this permission will mean I am not eligible for
Lifeline service. I also authorize Assist Wireless to access any records required to verify my statements herein
and to confirm my continued eligibility for Lifeline assistance. I understand that if I move, I must provide a
new address to Assist Wireless within 30 days of my move. I understand that if I provided a Temporary Address, I
must verify with Assist Wireless every 90 days that I am using the same address. I understand that if I fail to
do so, I will lose my Lifeline discount. By my signature, I certify under penalty of perjury that I have read
and understood this form and that I attest that the information contained in this application that I have
provided is true and correct to the best of my knowledge and that I acknowledge that providing false or
fraudulent information to receive Lifeline benefits is punishable by law.
Thank you for accepting the Terms & Conditions! We will need to verify that you or
someone in your home does
not already receive Lifeline service and check whether your household qualifies for government supported cell
Please Note: the address you enter must match the address on your identification documents.
You may only select one qualifying eligibility method from below. You will need to send us a photo or scan of your eligibility document later. If you qualify through multiple means, please select the option that you can prove eligibility most easily.
If you chose Income at or below 135% of FPG please select the income level you are at and how many people are in your household.
Lifeline is a government program that provides a monthly discount on home or mobile telephone services. Only ONE Lifeline discount is allowed per household. Members of a household are not permitted to receive Lifeline service from multiple telephone companies. Your household is everyone who lives together at your address as one economic unit (including children and people who are not related to you). The adults you live with are part of your economic unit if they contribute to and share in the income and expenses of the household. An adult is any person 18 years of age or older, or an emancipated minor (a person under age 18 who is legally considered to be an adult). Household expenses include food, health care expenses (such as medical bills) and the cost of renting or paying a mortgage on your place of residence (a house or apartment, for example) and utilities (including water, heat and electricity). Income includes salary, public assistance benefits, social security payments, pensions, unemployment compensation, veteran's benefits, inheritances, alimony, child support payments, worker's compensation benefits, gifts, and lottery winnings. Spouses and domestic partners are considered to be part of the same household. Children under the age of 18 living with their parents or guardians are considered to be part of the same household as their parents or guardians. If an adult has no income, or minimal income, and lives with someone who provides financial support to that adult, both people are considered part of the same household.
Does your spouse or domestic partner currently receive Lifeline-discounted phone service? (Check No if you do not have a spouse or partner)
Other than a spouse or partner, do other adults (people over the age of 18 or emancipated minors) live with you at your address?
Do you share living expenses (bills, food, etc.) and share income (either your income, the other person's income or both incomes together) with at least one of the adults listed above? (Check No if you selected None from above)
Please complete if benefits selected are in a name other than applicant - (i.e. Free Lunch Program)
Congratulations, your application for Lifeline supported cell phone service from Assist Wireless is pending approval. We need
just a little more information to complete your application. Because Lifeline is a government supported program, we are required
to gather personal information to identify you and approve your Lifeline service. Your information WILL NOT be shared with any outside party.
Is your address a temporary residence?
If providing a temporary residential address in this application, you are required to contact Assist Wireless every 90 days to verify your temporary address.
Does more than one family live at your address?
Enrollment ID: 93876
Enrollment Status: Pending
Download Your Enrollment Form
Your personal information has been received! All we need now is a copy of your Photo ID and Eligibility Document.
Below are instructions to submit your documents to complete your Enrollment Application. Should you need help or assistance contact our customer
service line Toll-Free at 1-855-392-7747.
Below are instructions to upload your document to complete your Enrollment Application.
Click to Upload
Before your enrollment for Lifeline Service is submitted to Assist Wireless, you MUST submit a
copy of your Photo ID and Eligibility Documents.
To help us ensure timely processing of your documents, please select the method of submission
you plan to use:
Sorry, but Assist Wireless is not currently available in your area. Check back at a later time.
We cannot fill your request. There can only be one Lifeline benefit per eligible household.
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