Triangle Communications Lifeline Application

SECTION 1 - Applicant Information
The Applicant is the person who has telephone service with the telephone company. 

SECTION 2 - Eligibility Information
I certify that I, my dependent, or my household receives assistance from at least one of the programs listed below, or that my total household income is at or below 135% of the Federal Poverty Guidelines.

2015 135% of the Federal Poverty Guidelines (annual household income before tax)
1 person up to $15,980 per year | 2 people up to $21,506 | 3 people up to $27,122 | 4 people up to $32,738 | Add $5,616 for each extra person

If you checked Total Household Income at or below 135% of federal poverty guidelines above, provide the number of people in your household.

SECTION 3 - Certification

Lifeline is a federal benefit that makes monthly telephone service more affordable for eligible households. Your household may receive Lifeline on one wireless OR one home telephone, but not both. Your household may not receive the Lifeline benefit from more than one telephone company. For the purpose of Lifeline, a household is an individual or any group of individuals who live together at the same address and share income or expenses. You may not transfer your Lifeline discount to another person, even if he or she is eligible. You may lose your Lifeline benefit and may be prosecuted by the United States government if you violate the one-per-household rule or otherwise make false statements to receive Lifeline.