Affordable Connectivity Program Application Form FCC Form 5645
FCC Form 5645 is an application form for the Affordable Connectivity Program (ACP) that provides monthly internet service discounts and a one-time device benefit for qualifying low-income consumers. The form includes sections for personal information, identity verification, and household details. Instructions for submission and required documentation are also provided.
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How do I fill this out?
To fill out this form, you will need to provide your personal information and verify your identity. Make sure to use only capitalized letters and black ink. Complete the required sections, initial every agreement statement, and sign on page 7.
How to fill out the Affordable Connectivity Program Application Form FCC Form 5645?
1
Provide your full legal name.
2
Enter your phone number and date of birth.
3
Verify your identity using one of the provided options.
4
Fill in your home and mailing addresses.
5
Sign and submit the form with all required documentation.
Who needs the Affordable Connectivity Program Application Form FCC Form 5645?
1
Low-income consumers who need assistance with internet service costs.
2
Households on Tribal lands seeking internet service discounts.
3
Individuals qualifying for government assistance programs needing internet access.
4
Consumers looking for a one-time connected device benefit.
5
Households that qualify for both the ACP and Lifeline programs.
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With PrintFriendly, you can easily edit your ACP Application Form by entering your information directly into the provided fields. Our PDF editor allows you to make changes and corrections as needed. Once you're satisfied, you can save and download the updated form.
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With PrintFriendly, you can easily edit your ACP Application Form by entering your information directly into the provided fields. Our PDF editor allows you to make changes and corrections as needed. Once you're satisfied, you can save and download the updated form.
1
Open the ACP Application Form in PrintFriendly's PDF editor.
2
Enter your information directly into the provided fields.
3
Make any necessary changes or corrections.
4
Use the editor tools to sign the form digitally.
5
Save and download the edited and signed form.
What are the instructions for submitting this form?
To submit the ACP Application Form, fill out all required sections, initial every agreement statement, and sign on page 7. You can apply online at AffordableConnectivity.gov for fastest processing. Otherwise, mail the completed form to USAC, ACP Support Center, P.O. Box 9100, Wilkes-Barre, PA 18773. For additional assistance, call the ACP Support Center at 1-877-384-2575. It's recommended to include all required documentation to speed up processing.
What are the important dates for this form in 2024 and 2025?
Important dates for the ACP Application Form in 2024 and 2025 include the annual renewal deadlines and program updates announced by the FCC. Specific dates can be found on the Affordable Connectivity Program website.
What is the purpose of this form?
The purpose of the Affordable Connectivity Program (ACP) Application Form is to provide eligible low-income households with discounts on their monthly internet service and a one-time benefit for a connected device. This federal program, administered by the Federal Communications Commission (FCC), aims to make internet access more affordable for qualifying consumers. By completing the ACP Application Form, households can receive up to $30 per month to cover internet service costs, with additional benefits for those on Tribal lands.
Tell me about this form and its components and fields line-by-line.
- 1. Full Legal Name: Your official name as it appears on documents like your Social Security Card or State ID.
- 2. Phone Number: A contact number where you can be reached if you have one.
- 3. Date of Birth: Your birth date including the month, day, and year.
- 4. Email Address: An optional but recommended field for electronic communication.
- 5. Identity Verification: Options to verify your identity include the last four digits of your Social Security number, Tribal Identification number, Driver's License, Military ID, Passport, or other Government ID.
- 6. Home Address: The address where you will receive the service, excluding P.O. Box addresses.
- 7. Temporary Address: Indicate if the provided home address is temporary.
- 8. Tribal Lands: Check if you live on qualifying Tribal lands.
- 9. Mailing Address: Your mailing address if different from your home address.
What happens if I fail to submit this form?
If you fail to submit the ACP Application Form, you will not receive the benefits of the Affordable Connectivity Program. This can result in continued financial strain in paying for internet services.
- Loss of Internet Service Discounts: Failure to apply will result in not receiving the monthly discount on your internet service.
- Ineligibility for Device Benefit: You will not be able to receive the one-time benefit for a connected device if the form is not submitted.
- Missed Financial Assistance: Not receiving the ACP benefit means losing out on potential savings for your household.
How do I know when to use this form?
- 1. Low-Income Qualification: If you meet the low-income criteria set by the FCC, use this form to apply for benefits.
- 2. Participation in Assistance Programs: If you are participating in qualifying government assistance programs, use this form for ACP benefits.
- 3. Residing on Tribal Lands: If you live on qualifying Tribal lands, use this form to apply for enhanced discounts.
Frequently Asked Question
How do I fill out the ACP Application Form?
Use PrintFriendly's PDF editor to enter your information directly into the fields, ensuring all required sections are completed, and use capitalized letters.
Can I verify my identity online for the ACP?
Yes, you can use PrintFriendly's PDF editor to provide identity verification information directly on the form.
How do I sign the ACP Application Form?
Use PrintFriendly's PDF editor to add your digital signature in the designated area on the form.
Can I save my completed ACP form on PrintFriendly?
You can save and download your completed ACP form directly from PrintFriendly after filling it out and signing it.
How do I share my completed ACP form?
Use PrintFriendly's sharing options to email the document or generate a shareable link for easy submission.
What do I need to provide for identity verification?
You can use the last four digits of your Social Security number, Tribal Identification number, or a Government ID such as a driver’s license.
Where do I send the completed ACP Application Form?
Mail the form to USAC, ACP Support Center, P.O. Box 9100, Wilkes-Barre, PA 18773.
Can I apply for both ACP and Lifeline benefits?
Yes, qualifying households can apply for and receive both ACP and Lifeline benefits.
What should I do if my internet company doesn't participate in ACP?
Check with your internet company to determine if it meets the criteria to participate in the ACP program.
What happens if I provide false information on the form?
Providing false or fraudulent information will result in losing the ACP benefit and possible legal actions, including fines or imprisonment.
