Lifeline - Additional Forms
Forms for National Verifier States (Colorado, Mississippi, Utah, Hawaii, Idaho, Missouri, Pennsylvania, Rhode Island, Kentucky, Michigan)
- Lifeline Application Form - National Verifier States
- Lifeline Application Form - National Verifier States - Spanish
- Lifeline Recertification Form - National Verifier States
- Lifeline Recertification Form - National Verifier States - Spanish
Forms for Non-National Verifier States (Arkansas, Louisiana, Massachusetts, Maryland, Minnesota, Ohio, Oklahoma, Puerto Rico, Texas, South Carolina, Wisconsin, Arizona, Georgia, Iowa, Kansas, Nevada, West Virginia)
Unresolved questions or complaints: May be directed to your local Public Utilities Commission or customers in the states listed below may direct unresolved questions or complaints to the following organizations:
Colorado: External Affairs Section, Consumer Affairs: Colorado Public Utilities Commission: 1560 Broadway, Suite 250, Colorado 80202: Phone 303‐894¬2070 or 800‐456‐0858 Fax 303‐894‐2532 or E‐mail: email@example.com.
Georgia: Georgia Public Service Commission's Consumer Affairs Unit: 404-656-4501 or 1-800-292-5813.
Kansas: Kansas Corporation Commission: Office of Public Affairs and Consumer Protection: KCC‐Consumer Protection: 1500 SW Arrowhead Road, Topeka, KS 66604 or toll‐free 800‐662‐0027 or in Topeka 785‐271‐ 3140. Hearing or speech impaired TDD Kansas Relay Center 800‐766‐3777.
Massachusetts: Massachusetts Consumer Division: Department of Telecommunications and Cable Consumer Division: 1000 Washington Street, Suite 820, Boston, MA 02118‐6500: 617‐988‐8288 (Fax) Or by calling: 617‐305‐3531 1‐800‐392‐6066 (Toll free) firstname.lastname@example.org.
Pennsylvania Utility Commission Bureau of Consumer Services – 800-692-7380 or for FDD PA Relay Center 800-682-8706 (voice) or 800-682-8786 (TTY)
This is a Lifeline service. Lifeline is a government assistance program. Your Lifeline Benefit is non-transferable. Proof of eligibility is required and only eligible customers may enroll. Only one Lifeline discount per household. Consumers who willfully make false statements in order to obtain the Lifeline benefit can be punished by fine or imprisonment or being barred from the program. Offers vary by state and may not be available in all service areas. Global Connection Inc. of America d/b/a StandUp Wireless. Visit www.standupwireless.com/terms-conditions/ for complete terms & conditions.