SafeLink Wireless Enrollment

ESPAÑOL

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Household Worksheet

Please read and acknowledge the following:

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  1. Does your spouse or domestic partner (that is, someone you are married to or in a relationship with) already receive a California LifeLine-discounted phone? (Check NO if you do not have a spouse or partner)?

NO

YES

  • If you checked YES, you may not sign up for California LifeLine because someone in your household already receives the discount. Only ONE California LifeLine discount is allowed per household.
  • If you checked NO, please answer question #2.
  1. Other than a spouse or partner, do other adults (people over the age of 18 or emancipated minors) live with me at my address?

NO

YES

– A parent

NO

YES

– An adult son or daughter

NO

YES

– Another adult relative (such as sibling, aunt, cousin, grandparent, grandchild, etc.)

NO

YES

– An adult roommate

NO

YES

NO

YES

  • If you checked NO for each statement above, please skip the next questions and certify line B below.
  • If you checked YES, please answer question #3.
  1. Do you share living expenses (bill, food, etc.) and share income (either your income, the other person’s income or both incomes together) with at least one of the adults listed above in question #2?

NO

YES

  • If you checked NO, then your address includes more than one household. Please certify lines A and B below.
  • If you checked YES, then your address includes only one household. You may not sign up for California LifeLine because someone in your household already receives California LifeLine.
CERTIFICATION

  1. I certify that there are multiple households at my service address.

NO

YES

  1. I understand that the violation of the one-per-household requirement is against the Federal Communication Commission’s rules and may result in me losing my California LifeLine discounts, and potentially, prosecution by the United States government.

NO

YES

CONTINUE

If you have questions about the application process, call 1-800-SafeLink (723-3546).


SafeLink Wireless® is a Federal and California LifeLine Service, a government assistance program. Only eligible subscribers may enroll, and service is limited to one per household. Service is non-transferrable. Unlike a traditional wireline phone, a wireless handset may be removed from the home. By removing a wireless cell phone from a residence that does not have other phone services, residents may not have a way to make 911 calls during an emergency. Also, wireless service may experience interruptions due to weather conditions, terrain or gaps in servie coverage. Coverage not available in all areas. SafeLink is provided by TracFone Wireless Inc. The Android robot is reproduced or modified from work created and shared by Google and used according to terms and conditions described in the Creative Commons 3.0 Attribution License.

Dr Olga

http://www.olgalazin.com

My Blog: http://olgaandreimagda.blogspot.com

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