Lifeline

Forms

Carriers must file online.Click here for Prior Year Forms

Reimbursement Claims

*NEW* Lifeline Claims System

Reimbursement Claims and Revisions for 2018 Data Months

File Online (using E-File credentials)

 

LCS User Guide

LCS Upload Validation Rules

FCC Form 497:Lifeline Worksheet

Note: Do not use FCC Form 497 for data months in 2018 and later. Instead, use the Lifeline Claims System (available via NLAD).

For data months December 2016 to December 2017:
File Online
FCC Form 497
FCC Form 497 (editable)
FCC Form 497 bulk upload

 

FCC Form 497 Instructions (updated 12/28/16)

FCC Form 497 Online Filing Instructions

Establishing User Entitlements

Learn more on the Claim Reimbursement page.

Annual Filings

FCC Form 481

File Online

FCC Form 481 Template

Carrier Annual Reporting Data Collection Form

FCC Form 481 Instructions

FCC Form 481 Upload Templates

FCC Form 555 (For Recertification Data)

File Online

FCC Form 555 bulk upload

Annual Lifeline Eligible Telecommunications Carrier Certification Form

FCC Form 555 Instructions

Learn more on the FCC Form 555 page.

Consumer Forms

Non-National Verifier Forms

FCC Form 5629: Lifeline Application Form

FCC Form 5631:One-Per-Household Worksheet

FCC Form 5630: Annual Recertification Form

Spanish language:

FCC Form 5629 (Spanish) - Lifeline Application Form

FCC Form 5631 (Spanish) - One-Per-Household Worksheet

FCC Form 5630(Spanish) - Recertification Form

English and Spanish application forms, household worksheets, and recertification forms for non-National Verifier states.

Learn more on the Universal Lifeline Consumer Forms web page.

National Verifier Forms

OFFICIAL National Verifier Application Form

OFFICIAL National Verifier One-Per-Household Worksheet

OFFICIAL National Verifier Recertification Form

The paper application, household worksheet, and recertification forms for use in National Verifier states (CO, MS, MT, NM, UT, WY).