Lifeline is a non-transferable government assistance program that makes monthly telephone service more affordable for eligible consumers. Your household may receive Lifeline on one mobile (wireless) OR one landline (home) telephone, but not both. For the purpose of Lifeline, a household is an individual or any group of individuals who live together at the the same address and share income or expenses. Contact your Triangle Customer Service Representative for more information regarding these programs.
Since you do not receive assistance for any of the above programs, you must attach proof that your hoursehold income is at or below 135% of the Federal Poverty Guidelines.2014 Federal Poverty Levels for Lifeline Eligibility (based on the number of people in the household) 1 person $15,755 2 people $21,236 3 people $26,717 4 people $32,198 5 people $37,679 6 people $43,160 7 people $48,641 8 people $54,122 Each additional person +$5,
Terms and ConditionsI must notify Triangle Communications within 30 days if:
I understand that:
I certify, under penalty of perjury that the above information is true, that my household receives only one Lifeline-supported service and no one in my household receives Lifeline from another telephone company. The above information is true that my household receives only one Lifeline supported service and no one in my household receives Lifeline from another telephone company
By signing below: I give Triangle Communications permission to give my name, telephone number and address to the Universal Service Administrative Company (USAC) or its agent to confirm that my household only receives one Lifeline benefit. If USAC finds that my household receives more than one Lifeline benefit, USAC will notify the telephone companies, and I will have to select one service and I will be de-enrolled from the other (required to receive discount).
For Office Use OnlyType of documentation reviewed
This form was created in accordance with the FCC's Lifeline rules by John Staurulakis, Inc.
Thank you for your submission.