Form FCC Form 5629 FCC Form 5629 Lifeline Application Universal Form
Bridging the Digital Divide for Low-Income Consumers, Lifeline and Link Up Reform and Modernization, Telecommunications Carriers Eligible for Universal Service Support
Lifeline Application 5629 (New PO Box)
Individuals or Households
OMB: 3060-0819
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 3060-0819 can be found here: