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KANSAS LIFELINE CERTIFICATION FORM COMPANY INFORMATION 1009 Lincoln St PO Box 25 Cameo, KS 66547 7854561000 Representative: Account Number: SUBSCRIBER INFORMATION Subscribers Full Name: Subscribers
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How to fill out kansas lifeline certification form

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How to fill out Kansas Lifeline certification form:

01
Start by downloading the Kansas Lifeline certification form from the official website of the Kansas Lifeline program.
02
Fill out the personal information section, including your full name, address, phone number, and date of birth.
03
Provide proof of your eligibility for the Lifeline program. This can include documents such as a recent tax return, a Medicaid card, or a letter from a qualifying government assistance program.
04
Indicate your choice of Lifeline service provider by selecting their name from the provided list or writing it in if it is not listed.
05
Read and sign the certification statement, confirming that all the information provided is accurate to the best of your knowledge.
06
Attach any required documentation or proof of eligibility as outlined in the instructions.
07
Review the completed form to ensure all fields are filled out correctly and all necessary documents are included.
08
Make a copy of the completed form and any attached documents for your own records.
09
Submit the completed form and attachments by mail or online, as specified in the instructions.
10
If submitting by mail, make sure to include the correct mailing address and any additional fees, if applicable.

Who needs Kansas Lifeline certification form:

01
Individuals who meet the eligibility criteria for the Lifeline program in Kansas.
02
Those who are seeking affordable telephone or internet services and are currently receiving government assistance or have a household income at or below 135% of the federal poverty guidelines.
03
Anyone who wishes to apply for the Lifeline program benefits and believes they meet the requirements set by the Kansas Lifeline program.
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The Kansas Lifeline Certification Form is a document that eligible consumers must fill out to verify their eligibility for the Lifeline assistance program.
Individuals who meet the eligibility requirements for the Lifeline assistance program are required to file the Kansas Lifeline Certification Form.
To fill out the Kansas Lifeline Certification Form, individuals must provide personal information, proof of eligibility, and sign the form to certify the accuracy of the information.
The purpose of the Kansas Lifeline Certification Form is to verify the eligibility of consumers for the Lifeline assistance program.
The Kansas Lifeline Certification Form requires information such as name, address, income, and documentation to prove eligibility for the Lifeline assistance program.
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