Affordable Connectivity Program Transfer Exception Worksheet
This file is for transferring your Affordable Connectivity Program (ACP) benefit. It provides a monthly internet service discount and a one-time connected device benefit. Use it if you need an exemption for an additional transfer within this calendar month.
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How do I fill this out?
To fill out this form, you need to check the appropriate statement that applies to your household. Make sure all information is true and correct to the best of your knowledge. Sign and date the form to complete it.
How to fill out the Affordable Connectivity Program Transfer Exception Worksheet?
1
Check the appropriate statement that applies to your household.
2
Enter your full legal name.
3
Provide the date.
4
Enter the representative ID if applicable.
5
Sign the form.
Who needs the Affordable Connectivity Program Transfer Exception Worksheet?
1
Consumers who believe their internet company transferred their ACP benefit without consent.
2
Households whose internet company stopped operating or failed to provide service.
3
Individuals who moved to a location outside of their current internet company's service area.
4
Consumers needing to transfer their ACP benefit to a new internet provider.
5
Low-income households qualifying for the ACP benefit.
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With PrintFriendly, you can easily edit this PDF to meet your specific needs. Use our powerful PDF editor to check applicable statements, enter required details, and make corrections. Ensure all provided information is accurate before saving and downloading your edited file.
1
Open the PDF in PrintFriendly's editor.
2
Check the appropriate statement that applies to your household.
3
Enter your full legal name and today's date.
4
Provide the representative ID if applicable.
5
Sign the form and save your changes.
What are the instructions for submitting this form?
Submit this form to the Universal Service Administrative Company. You may submit it through online submission forms, by email, fax, or physical mail. For emails, send to acpsupport@usac.org. For fax, use 1-877-384-2575. For physical addresses, mail the completed form to 700 12th Street NW, Suite 900, Washington, DC 20005. Ensure all required fields are filled out and signed before submission. It is advisable to keep a copy for your records.
What are the important dates for this form in 2024 and 2025?
Deadlines for submitting this form can vary. Check with your specific program guidelines for 2024 and 2025 deadlines.
What is the purpose of this form?
The purpose of this form is to provide a method for participants in the Affordable Connectivity Program (ACP) to request an exemption for an additional transfer of their ACP benefit within the calendar month. This ensures that households experiencing service disruption or unauthorized benefit transfers can maintain their internet service. Accurate completion and submission of this form are crucial for processing these exceptions.
Tell me about this form and its components and fields line-by-line.
- 1. Statement Check Boxes: Check the appropriate statement that applies to your household's situation.
- 2. Full Legal Name: Enter your full legal name as it appears on official documents.
- 3. Date: Provide today's date when you are filling out the form.
- 4. Representative ID: Enter the representative ID if a representative assisted in completing the form.
- 5. Signature: Sign the form to verify the accuracy of the provided information.
What happens if I fail to submit this form?
Failure to submit this form can result in the denial of your ACP benefit transfer request.
- Service Interruption: Your internet service may be disrupted.
- Benefit Denial: You may not receive the ACP benefit for which you are eligible.
How do I know when to use this form?
- 1. Unauthorized Transfer: If you believe your benefit was transferred without your consent.
- 2. Service Discontinuation: If your internet provider stopped operating or providing service.
- 3. Relocation: If you moved to a new location outside your current provider's service area.
Frequently Asked Question
Can I transfer my ACP benefit without an exemption?
No, this form is specifically for those needing an exemption to transfer their ACP benefit.
What information do I need to provide?
You need to check the applicable statement, enter your full legal name, date, representative ID if applicable, and sign the form.
How do I edit the PDF?
Use PrintFriendly's PDF editor to check statements, enter details, and correct information.
Can I sign the PDF online?
Yes, PrintFriendly allows you to sign the PDF using our digital signature feature.
How do I share the completed form?
You can share the form directly from PrintFriendly via email or other sharing options provided.
Is the form submission mandatory?
Yes, submitting the form is essential to process your ACP benefit transfer request.
Can I download the edited PDF?
Yes, once you edit the PDF using PrintFriendly, you can download the completed form.
What if I need help filling out the form?
Contact the ACP Support Center at the provided number for assistance.
Do I need a representative ID?
Provide a representative ID only if a representative helped you complete the form.
What happens if I don't submit the form?
Failure to submit the form may result in the denial of your ACP benefit transfer request.
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