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EXHIBIT 3 Sample Lifeline Certification Force:::ssWIRELESSIf you have any questions call 18004646010SOUTH DAKOTA LIFELINE CERTIFICATION FORM This signed authorization is required in order to enroll
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How to fill out sample lifeline certification form

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Start by gathering all the necessary information and documents, such as your personal details, income documents, and proof of participation in a qualifying government assistance program.
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Carefully read through the instructions and guidelines provided with the lifeline certification form.
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Fill out the form accurately and completely, providing all the required information in the designated fields.
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Who needs sample lifeline certification form?

01
Anyone who meets the eligibility criteria and wishes to apply for the Lifeline program can use the sample lifeline certification form.
02
Low-income individuals or households who receive government assistance and want to avail discounted phone or internet services can also make use of this form.
03
Individuals enrolled in specific federal assistance programs such as Medicaid, Supplemental Nutrition Assistance Program (SNAP), Federal Public Housing Assistance (FPHA), or Veterans Pension and Survivor's Benefit are eligible for Lifeline program benefits and, therefore, may need to fill out the sample lifeline certification form.
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The sample lifeline certification form is a document used to verify an individual's eligibility for the Lifeline Program.
Individuals who wish to participate in the Lifeline Program are required to file the sample lifeline certification form.
To fill out the sample lifeline certification form, individuals need to provide accurate information about their income, household size, and any government assistance programs they are enrolled in.
The purpose of the sample lifeline certification form is to ensure that only eligible individuals receive discounted phone and internet services through the Lifeline Program.
The sample lifeline certification form requires individuals to report their income, household size, and any government assistance programs they are enrolled in.
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