Lifeline government assisted phone service requires a signed Lifeline Certification form
be submitted before the order can be processed.
If you placed your order on-line, your lifeline certification was submitted during that process.
If you ordered service over the phone, you'll need to complete and submit a form here. Many states have an on-line form that can be done by logging into the customer portal. If available for your state, you may use this method by clicking your state in the table below.
If you prefer, or if a customer portal isn't available for your state, click youor state in the second table below which will brin up a printable, pdf form. Print then fill out this form and return it to us.
|Click your state for the proper form:|
|Printable pdf Forms|
|Use one of the following to return the completed form to us.
Limited Time Promotions!
*For lifeline qualified customers (participating in government assistance) in the AT&T areas. Not available in all states.
Would you like to get lifeline assistance on a wireless phone plan instead of home phone?
You can get up to 1000 free minutes per month on a government assisted cell phone for free if you qualify for Lifeline.
Lifeline assistance is permitted on just on phone per household. You cannot receive Lifeline assistance on your mobile phone if you already receive it on your home phone.