Safelink Application PDF Details

Safelink Wireless is a Lifeline assistance program that provides free government phones and service to eligible low-income residents. The Safelink application form is simple and easy to fill out, but there are a few things you need to know before you apply. In this post, we'll tell you everything you need to know about the Safelink application process, including what documents you need to provide, how much service coverage you can expect, and how to renew your Safelink benefits.

Here is the details concerning the form you were in search of to fill out. It will show you how long it should take to fill out safelink application, exactly what fields you will need to fill in and some further specific facts.

Form NameSafelink Application
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namessafelink phone application, safelink, safelink wireless application georgia, apply for safelink

Form Preview Example

3 easys steps



Conirm your correct home address and select if you live at a temporary address. Provide mailing address if diferent.

Qualifying Home Address (No P.O. Box)

Mailing Address if diferent from your Qualifying Home Address (P.O. Box Allowed)

Select if address is temporary: o


Address/Apt. No.




Zip code

Please provide ONLYVALID personal information for ALL (*) REQUIRED FIELDS. It will be validated against public records and any discrepancies will result in REJECTION of your application.

*First Name






*Last Name











*Last Four Digits of Social Security #

*Birth Date (Month/Day/Year)




Contact Phone Number












Email Address











Plan Features

Choose your plan (check one)

Local Calls

National Long Distance

Voice Mail

Nationwide Texting

Roaming at no Additional Cost

Free 911

411 Directory Assistance at no Additional Cost Carry-Over Minutes from Month to Month

100+ International Long Distance Destinations*








(Up to 1250 texts)













(Up to 1250 texts)









(Up to 1250 texts)



*List of destinations available at

**If you choose this plan, your unused minutes will be removed/wiped out and will not carry-over on your next monthly minutes delivery. However, if you purchase and redeem additional minutes cards, all unused minutes will carry over for three consecutive months.

Select ONE of the two options below (Proof of eligibility MUST be submitted for either option, name and address must match applicant).


Qualify by certifying you belong to ONE of the programs listed below,


programs with (*) DO NOT require proof. Remaining programs require


an award letter from SSA or state agency stating that you receive the


beneit, or a similar oicial document. Provide Copies ONLY


oSupplemental Nutrition Assistance Program (SNAP) Food Stamps*

oCash Assistance or Temporary Assistance for Needy Families (TANF) or Family Independence Program*


oSupplemental Security Income (SSI)

oFederal Public Housing Assistance (Section 8)

oLow-Income Home Energy Assistance Program (LIHEAP)

oNational School Lunch Program’s (Free Lunch Program)

*Programs are validated by a state agency (No Proof required)

Qualify by checking the number of people in your family and your monthly income, attach proof of income such as last year’s Federal or State Income Tax return, a Social Security statement of beneit, a letter from your employer, pay stubs from 3 consecutive months, an Unemployment or Workmen’s Compen- sation statement of beneits, a Retirement/Pension statement of beneits or a divorce decree, child support award, or other oicial document containing income information. Provide Copies ONLY

Household Income MUST be at or below the guidelines in table below:


Persons in Family or Household


Annual Income

Monthly Income












































































For each additional person, add:














SafeLink®isaLifelinesupportedservice. Lifelineisafederalbenefit,andonlyeligiblesubscribersmayenroll. Customerswhowillfullymakefalsestatementsinordertoobtainthe benefit can be punished by fine or imprisonment or can be barred from the program.

Lifelineisavailablefor only onelineperhousehold. Ahouseholdisdefinedasanyindividualorgroupofindividualswholivetogetheratthe sameaddressandshareincomeand expenses. A household is not permitted to receive Lifeline benefits from multiple providers. Violation of the one-per-household rule constitutes a violation of FCC rules, and will result in the Customer’s disenrollment from Lifeline. Lifeline is a non-transferable benefit, and a Customer may not transfer his or her benefit to another person.

oCheck this box if you would like to receive pre-recorded special ofers and promotional ofers from TracFone at the Contact Telephone number provided above.


You MUST check of (a) all statements, then Sign and Date application. (Your application cannot be approved without these items)

I certify under penalty of perjury to each of the following:

Boxes MUST be checked of

o I participate in the above designated qualifying program OR have income at or below the level speciied above.

oI understand that I must notify SafeLink® within 30 days if I no longer participate in the qualifying program or meet the income eligibility threshold, if I or another member of my household obtains Lifeline supported service from another carrier, or, for any other reason, I no longer qualify for Lifeline support.

oI understand I may be required to recertify my continued eligibility for Lifeline at any time, and failure to do so will result in termination of my Lifeline beneits.

o If I change my address, I will provide my new address to SafeLink® within 30 days.

oMy household will receive only one Lifeline beneit and to the best of my knowledge, my household is not already receiving a Lifeline service.

oThe information contained in this application is true and accurate to the best of my knowledge, and I acknowledge that providing false or fraudulent information to obtain Lifeline beneits is punishable by law.

I authorize Safelink Wireless® or its duly appointed representative to: (1) access any records required to verify my statements herein; (2) to conirm my continued eligibility for Lifeline assistance; (3) to update my address to a proper mailing address format; (4) to provide my name, telephone number, and address to the Universal Service Administrative Company (USAC) (the administrator of the program) and/or its agents for the purpose of verifying that I do not receive more than one Lifeline beneit; and (5) authorize social service agency representatives to discuss with and/or provide information to Safelink Wireless® verifying my participation in beneit programs that qualify me for Lifeline assistance.

Safelink service is ofered pursuant to Safelink Terms and Conditions, which can be found at

By signing below, I separately airm and agree to each of the above statements.

Applicant Signature






For questions please call 1-800-SafeLink (1-800-723-3546)

Fax application to: 1-866-902-5756 Promo Code:

Mail application to: SafeLink Wireless® w PO Box 220009 w Milwaukie, OR 97269-0009





14644-SC Income App English

How to Edit Safelink Application Online for Free

It is easy to fill out documents working with our PDF editor. Updating the safelink com application document is not difficult for those who adhere to the following actions:

Step 1: Get the button "Get Form Here" and press it.

Step 2: When you have entered the editing page safelink com application, you should be able to notice each of the options intended for your file at the upper menu.

These parts are within the PDF form you will be creating.

entering details in safelink paper application step 1

Include the necessary particulars in the Qualify by certifying you belong, o Supplemental Nutrition, Qualify by checking the number of, Persons in Family or Household, Annual Income Monthly Income, For each additional person add, SafeLink is a Lifeline supported, Lifeline is available for only one, S E C T I O N, f o d e k c e h c e b T S U M s e, o o, o o, You MUST check of a all statements, I participate in the above, and another carrier or for any other field.

Completing safelink paper application part 2

Within the segment dealing with f o d e k c e h c e b T S U M s e, receiving a Lifeline service, The information contained in this, that providing false or fraudulent, I authorize Safelink Wireless or, Safelink service is ofered, By signing below I separately airm, Applicant Signature, For questions please call SafeLink, Date Fax application to Promo Code, Mail application to SafeLink, and SC Income App English, it's essential to write down some appropriate data.

part 3 to finishing safelink paper application

Step 3: In case you are done, choose the "Done" button to transfer the PDF form.

Step 4: Produce copies of the form. This would save you from upcoming problems. We don't read or share the information you have, thus you can relax knowing it's going to be safe.

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