You do not need a computer or an email address to get Lifeline, the federal program behind the free government phone. You can print the Lifeline application form, fill it in by hand, and mail it with copies of your documents. It is slower than applying online, but it reaches the same National Verifier system and gets the same result.
The official form is FCC Form 5629, the Lifeline Program Application Form. The current edition is dated February 2026 and runs 8 pages, and the form itself estimates it takes about 45 minutes to complete. This page covers where to get the form, what each section asks, the current mailing address, what to put in the envelope, and how long you will wait. If you can get online, even on a borrowed phone, the online route in our how to apply for Lifeline guide is usually faster.
Where to get the Lifeline application form
- Download it. LifelineSupport.org has the application in English and Spanish on its How to Apply page. Print every page. According to the Lifeline FAQ, instructions for the paper form come in 10 languages.
- Ask for one by phone. Call the Lifeline Support Center at 800-234-9473 and ask them to mail you a form. The line is open 9 a.m. to 9 p.m. Eastern, seven days a week.
- Ask a Lifeline company. Many companies that offer free phones can help you apply in person, which skips the mail entirely. See our list of Lifeline providers.
If you live in Texas or Oregon, do not use the national form. Texas applications go through the Texas Lifeline self-enrollment process, and Oregon applications go through the Oregon Public Utility Commission (800-848-4442). Since February 1, 2026, California residents applying for federal Lifeline use the national process like everyone else.
Be careful with the “Lifeline application PDF” copies posted on other websites. Some are old editions with an outdated mailing address. Download from LifelineSupport.org so you get the current form.
Where to mail your Lifeline application
Mail the completed form and your document copies to:
Lifeline Support Center, PO Box 1000, Horseheads, NY 14845
Older forms, flyers and websites list a Kentucky address (PO Box 7081, London, KY). LifelineSupport.org now lists the Horseheads, New York address, so use that one.
Online vs mail: what you give up by mailing
| Online (getinternet.gov) | By mail | |
|---|---|---|
| Decision time | Seconds if a database finds you; minutes for uploaded documents during 9 a.m. to 9 p.m. ET | 7 to 10 business days after your application arrives, plus mail time both ways |
| Fixing a problem | Upload a new document the same day | Mail another document and wait again |
| Tracking | Log in to your account any time | Call the Support Center or wait for a letter |
| What you need | A phone or computer and an email address | A printer (or a mailed form), stamps and copies of documents |
Because every fix takes another round of mail, a small mistake can add weeks. The section-by-section guide below is meant to get it right the first time.
The Lifeline application form, section by section
Here is what each part of FCC Form 5629 asks for, based on the February 2026 edition.
| Section | Page | What it asks | Who fills it in |
|---|---|---|---|
| 1. About Lifeline | 1 | Nothing to fill in. It explains the benefit, the one-per-household rule and the household definition. | Read only |
| 2a. Your information | 2 | Legal name, date of birth, phone, email, last four digits of your Social Security number or Tribal ID, how you want to be contacted | Everyone |
| 2b. Your information, continued | 3 | Home address, mailing address if different, whether the address is temporary, whether you live on Tribal lands | Everyone |
| 2c. Benefit qualifying person | 4 | Name, birth date and SSN last four (or Tribal ID) of the child or dependent who gets the benefit | Only if you qualify through someone else |
| 3. Qualify for Lifeline | 5 to 6 | Checkboxes for SNAP, Medicaid, SSI, Federal Public Housing Assistance, Veterans or Survivors Pension, Tribal programs, or the income option with household size | Everyone |
| 4. Agreement | 6 | Nine statements to initial, then your signature and date | Everyone |
| 5. Survivors | 7 | Extra questions for survivors of domestic violence applying under the Safe Connections Act | Only survivors |
| 6. Representative information | 8 | A Representative ID number | Only a registered company agent who helped you |
Section 2: your information
Use capital letters and black ink, as the instructions ask. Write your full legal name exactly as it appears on your ID. Nicknames and missing middle names are a common cause of identity errors.
Your home address must be where you live. If it is a shelter, a friend’s home or another place you stay for now, mark it as temporary. If you get mail somewhere else, fill in the mailing address too, or your decision letter may never reach you.
Section 3: how you qualify
Check only the programs you or your dependent actually get, and include proof of one of them. If you qualify on income, count everyone in your household who shares income and expenses, then compare with the limits in our Lifeline eligibility guide.
Section 4: the nine initials
This is where paper applications fail most often. The paper instructions say plainly that if you do not initial each statement, your application will be considered incomplete. The statements say, in short, that:
- You or someone in your household gets a listed benefit, or your income is at or below 135% of the poverty guidelines.
- You will give your company your new address within 30 days if you move.
- You will tell your company within 30 days if you stop qualifying.
- Your household gets only one Lifeline benefit.
- Your information can be collected, used and shared to run the program.
- Your answers are true.
- You understand that false information can lead to fines, jail, removal from the program or being barred from it.
- You must recertify by the deadline or lose the benefit.
- You answered truthfully about living on Tribal lands.
Initial all nine, then sign and date on the line below them.
How to fill out the paper form without mistakes
- Use your full legal name as it appears on your ID, and write clearly in capital letters.
- Give the last four digits of your Social Security number, or your Tribal ID number if you use one.
- Write your home address. If it is different from where you get mail, fill in both.
- Mark how you qualify: through a program (SNAP, Medicaid, SSI, Federal Public Housing Assistance, Veterans or Survivors Pension) or through income. Check the 2026 income limits first.
- If you qualify through a child or dependent, fill in their details in the section for the benefit qualifying person.
- Initial every program rule. A missing initial is one of the easiest ways to get a form sent back.
- Sign and date the form.
- If someone else at your address already has Lifeline, fill out and include the household worksheet.
Leave Section 6 blank unless a company agent helped you and gives you their Representative ID. Nobody should charge you for filling out the form.
What to put in the envelope
- The completed, signed application.
- Copies (not originals) of your proof of program participation or proof of income. Our guide to Lifeline documents lists what each document must show, including the 12-month date rule.
- A copy of your ID if your identity might not match records, for example after a name change.
- The household worksheet, if it applies to you.
Use a mailing option with tracking if you can, and keep a photo of every page you send.
State forms: California and Texas
California LifeLine. California has its own state program with its own form, separate from FCC Form 5629. You usually start with a participating phone company, and the California LifeLine Administrator then sends you an application to complete online or by mail. The California Public Utilities Commission says you must respond by the due date on that form. Its income limits run higher than the federal ones: $24,600 a year for one person and $50,800 for four, for June 1, 2026 to May 31, 2027. Getting the federal Lifeline discount in California now means a separate National Verifier application, although since September 17, 2026 a company may sign you up for both in one application if you clearly agree. See our California LifeLine guide for the full steps.
Texas Lifeline. Texas residents do not mail anything to Horseheads. The Texas Lifeline self-enrollment site (texaslifeline.org) is run for the Public Utility Commission of Texas and checks eligibility through state systems.
Company applications vs the federal form
Searches like “Assurance Wireless Lifeline application” or “Verizon Lifeline application” lead to the same place. Every company in the National Verifier states has to confirm your eligibility through the National Verifier before it can enroll you. The company’s online form is just a front end that sends your details there.
Not every big carrier takes Lifeline everywhere. Verizon, for example, lists Lifeline for its wireless customers only in Iowa, New York, North Dakota and Wisconsin, and asks you to call 800-417-3849 after you qualify to confirm it can give the discount at your address. The simplest way to see which companies serve you is the Companies Near Me search on LifelineSupport.org.
After you mail it
Plan on 7 to 10 business days from the day it arrives for a decision, which you will receive by mail. You can also call the Support Center to ask where it stands; our guide on how to check your Lifeline application status explains what each answer means. For the full timeline across every route, see how long Lifeline approval takes.
If the letter says you were not approved, it will give a reason. Our guide to a denied Lifeline application matches each reason to the fix. When you send more documents by mail, include the cover sheet so they are matched to your application.
Once you are approved, you have 90 days to sign up with a Lifeline company. If you get SNAP, keep your approval letter handy for that step too; our explainer on what SNAP is shows why that one letter matters for so many programs.
Lifeline application form FAQ
Is there a fee for the Lifeline application? No. The form is free to download, and there is no charge to apply.
Can I fill out the PDF on my computer and print it? The instructions ask for capital letters and black ink, which suits a printed form filled in by hand. Whatever you do, the form still needs your handwritten initials and signature.
Can someone help me fill it out? Yes. A family member can help you write it, but you sign it. The Lifeline Support Center at 800-234-9473 also answers questions and can help people with disabilities.
Is the Lifeline application the same as a Medicaid application? No. Medicaid has its own application through your state. If you are approved for Medicaid, you can use it to qualify for Lifeline.
Can I apply for a free tablet with this form? The form applies the discount to phone or internet service. Whether a company offers a tablet depends on the company; see our guide to the free government tablet with EBT.
Sources: LifelineSupport.org: How to Apply, USAC: Eligibility Verification, Oregon PUC: Oregon Lifeline, Lifeline Program Application Form, FCC Form 5629, Lifeline Paper Application Instructions (USAC), LifelineSupport.org: FAQs, LifelineSupport.org: Get Help, LifelineSupport.org: Documents Needed, CPUC: California LifeLine Eligibility, Verizon: Lifeline Availability, USAC: Eligibility Application Resolution, Telecompetitor: California untangles Lifeline confusion