Apply for SafeLink Wireless
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Personal Information

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State Benefits
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Shipping Address

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Privacy Law

To get your 100 free bonus minutes and free health reminder texts from AMERIGROUP, make sure you check yes:

* Important Notice:

The State of Texas might be providing you with a monthly discount on your Local Line. This is equivalent to the FREE minutes you will receive from SafeLink. Not everyone receives this discount, please check your telephone bill or call your local provider for confirmation. If you choose to have SafeLink service and are currently receiving this benefit, you will stop receiving this discount and receive a FREE cell phone with FREE Monthly minutes.

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Plan Information

Tap which plan the applicant would like.

New customers will receive an additional
250 free bonus minutes and unlimited texts,
that’s a total of 500 free minutes
for the first 4 months


Plan is required.

Qualification

Eligibility - Please select applicant's eligibility method

(Medicaid, FoodStamps, Section 8, etc.)



Eligible

Child or Dependent Personal Information

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Qualification

Program Certification - Select which programs the applicant participates in

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DCN Validator. (*) Please provide your 8 digits DCN number also known as your MO HealthNet. This number is assigned to program participants of MO HealthNet, Food Stamps, LIHEAP, and TANF (DCN required).
SafeLink is a Lifeline supported service. Lifeline is a federal benefit, and only eligible subscribers may enroll. Customers who willfully make false statements in order to obtain the benefit can be punished by fine or imprisonment or can be barred from the program. Lifeline is available for only one line per household. A household is defined as any individual or group of individuals who live together at the same address and share income and 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 Customers deenrollment from Lifeline. Lifeline is a non-transferable benefit, and a Customer may not transfer his or her benefit to another person.
SafeLink is a Lifeline supported service. Lifeline is a federal benefit, and only eligible subscribers may enroll. Customers who willfully make false statements in order to obtain the benefit can be punished by a fine up to one thousand dollars ($1,000.00) or imprisonment or can be barred from the program. Lifeline is available for only one line per household. A household is defined as any individual or group of individuals who live together at the same address and share income and 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 deenrollment from Lifeline. Lifeline is a non-transferable benefit, and a Customer may not transfer his or her benefit to another person.

Qualification

Income Certification - Select the applicant's household income

Qualification

Income Certification - Select the applicant's household income

 
Number Persons in Household
Annual Income
Monthly Income
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Total Monthly Household Income Why ? (e.g., 2000)
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Total Yearly Household Income Why ? (e.g., 24000)
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Number of People Receiving Income Why ? (e.g., 4)
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Number of Children Under Age of 18 Why ? (e.g., 2)
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SafeLink is a Lifeline supported service. Lifeline is a federal benefit, and only eligible subscribers may enroll. Customers who willfully make false statements in order to obtain the benefit can be punished by fine or imprisonment or can be barred from the program. Lifeline is available for only one line per household. A household is defined as any individual or group of individuals who live together at the same address and share income and 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 Customers deenrollment from Lifeline. Lifeline is a non-transferable benefit, and a Customer may not transfer his or her benefit to another person.
SafeLink is a Lifeline supported service. Lifeline is a federal benefit, and only eligible subscribers may enroll. Customers who willfully make false statements in order to obtain the benefit can be punished by fine up to one thousand dollars ($1,000.00) or imprisonment or can be barred from the program. Lifeline is available for only one line per household. A household is defined as any individual or group of individuals who live together at the same address and share income and 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 deenrollment from Lifeline. Lifeline is a non-transferable benefit, and a Customer may not transfer his or her benefit to another person.

Qualification

Security Questions

Question IndexQuestion Text
Validate Quiz Question

Qualification

Security Questions

4.Question Text Validate Quiz Question

Disclaimer



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Child or dependant Personal Information

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Penalty of Perjury

Under title 18 U.S.C. § 1621, whoever willfully states as true any material matter which he does not believe to be true in a statement under penalty of perjury, is guilty of perjury and shall, except as otherwise expressly provided by law, be fined or imprisoned not more than five years, or both.
I acknowledge that providing fraudulent documentation/information in order to receive assistance is punishable by law.
Under title 18 U.S.C. § 1621, whoever willfully states as true any material matter which he does not believe to be true in a statement under penalty of perjury, is guilty of perjury and shall, except as otherwise expressly provided by law, be fined up to one thousand dollars ($1,000.00) or imprisoned, or can be barred from the program. I acknowledge that providing fraudulent documentation/information in order to receive assistance is punishable by law.

I certify under penalty of perjury that:

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Confirmation

Applicant Signature

Electronic Signature


By clicking the Confirm Signature button, you are electronically signing this form.
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We are sorry

Your request cannot be resolved now

If you need, you can contact us at 1-888-493-0771.

You've been trying to complete the application but the information you provided could not be validated.
Alternatively you can Download a Blank Application by clicking "Download Blank Application" button below, then print and mail or fax the application to us by following the instructions at the bottom of the application. Or you can choose to continue the application process and correct the information provided by clicking on "Continue Application process"



If you only participate in the WI Homestead Tax Credit (Schedule H) program, the Department of Revenue (DOR) requires your authorization in order to validate your eligibility. We will mail you a form with a return envelope to be filled, signed and sent to the Department of Revenue (DOR) to confirm your eligibility for the Lifeline service. Be aware that with this process it could take a few weeks to receive a response. Alternatively you can apply via Income qualification if your earnings are below the state's Federal Poverty Guidelines.

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I Don't Agree
Select Another Program
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We could not find an exact match for your address. please contact us at 1-888-493-0771.
The correct zip code for the address provided is {ZipCode}, which is not supported by Safelink Wireless.
We could not find an exact match for your address. Please contact us at 1-888-493-0771.
We detected that you already have a pending Enrollment. You are not required to create a new one at this time.
We detected that you already have a pending Enrollment. You are not required to create a new one at this time.
We detected that you already have a qualified Enrollment. You are not required to create a new one at this time.
We detected that you already have an active Enrollment. You are not required to create a new one at this time.
This is NOT a valid SafeLink Phone Number.
This is NOT a valid SafeLink Phone. We will try to recover your number from your previous application. If the new number is invalid a new phone will be shipped to your home address; If the number is valid we will activate your old number. If you have more questions please call 1-800-SafeLink.
There was an error processing your enrollment, please try again. If the problem persists please contact a system administrator.
According to our records the personal information that you provided for your child's or dependent, is already registered by a different applicant. Please review your information and try again, alternatively you can contact us at 1-800-723-3546 and speak to one of our agents.
The SSN is already found in our records. Only one phone per SSN is allowed.
The DSHS Client ID you entered is in use by another customer please check the number and try again.
The DSHS is required.
The DCN is required.
You can only receive the Lifeline benefit once. If you wish SafeLink Wireless to be your Lifeline provider please be sure that you don't receive the benefit from another carrier.
The SafeLink Phone Number is not valid or is missing. Please enter your SafeLink Phone Number.
You must answer only one question.
The Maryland Department of Human Resources (DHR) does not list you as an eligible individual for Lifeline Service. If you have any questions you may contact us at 1-888-493-0771.
You will not be able to continue with the current information. Please call us at 1-800-SafeLink (723-3546) for assistance.
You will not be able to continue due to the following reasons:
If you wish to enroll for the service, please call us at 1-800-SafeLink (723-3546).
According to the Public Records, we were unable to verify your personal information. If you wish to enroll for the service, please call us at 1-800-SafeLink (723-3546).
  • According to Public Records, the social security number provided does not exist or has not been issued.

  • We were unable to verify your personal information in the Public Records.

  • We were unable to verify your personal information in the Public Records.

  • The information you have provided does not match Public Records. Please verify and try again.

  • According to the Public Records, the address that you entered is invalid.

  • The information you have provided does not match Public Records. Please verify and try again.

  • The information you have provided does not match Public Records. Please verify and try again.

  • The information you have provided does not match Public Records. Please verify and try again.

  • The name listed in Public Records does not match the social security number and address provided.

  • No address was entered.

  • The legal first name and address listed in Public Records do not match the social security number provided.

  • We were unable to verify your social security number in Public Records.

  • Your information was flagged as fraudulent.

  • Your information was flagged as fraudulent.

  • Our records indicate that someone is already receiving or has already applied for service at your qualifying address. You will not be able to continue with enrollment.
    Electronically Signed by

    Important - Please Read

    Congratulations,

    You were pre-qualified for the Lifeline Program. You were chosen for this program because you are currently enrolled in the {WhiteListProgramCaptions} Program. Since, we were able to electronically verify your elegibility you do not need to provide proof of program participation.

    The TX PUC informed us that you might be involved on an enrollment attempt with another lifeline carrier. You will be unable to continue signing up with us at this time. You will be able to try again, during the next month. Please try again after the 6th day of the next calendar month. Thanks.
    The TX PUC informed us that you appear to receive lifeline benefits from another carrier. You will be unable to continue signing up with us at this time. You will be able to try again, if you confirm with the other carrier the cancellation of those benefits. Thanks.
    The communication with TX PUC Service failed. Please, try again later. Thanks.
    We are sorry but we were unable to validate the personal information provided (name, DOB or SSN). You will be required to present valid identity proof to complete the enrollment process. On the last step you will find examples of accepted types of proofs.
    Our records indicate that you are already receiving a Lifeline benefit from another provider. You will not be able to create a request for a new benefit at this time. Please try again in 30 days.
    Please review your personal information and try again. Alternatively, you can contact us at 1-800-723-3546 and speak to one of our agents.
    You appear as “enrolled” in Lifeline Benefits with another provider according to the National Lifeline Accountability Database (NLAD). We are unable to transfer you over this time. You will be able to transfer your benefit to SafeLink Wireless starting @DateTransfer. Please try again after that date.
    Your personal information was banned from signing up for Safelink Wireless for 30 days, due to the submission of a previous attempts, where your response to the Lifeline Household Worksheet questions indicate that you are not qualified to receive lifeline benefits. Please try again in 30 days if your household situation has changed. If you have any questions please contact Lifeline support center at 1-800-Safelink (723-3546).
    Agents with no profile picture cannot complete enrollments that require HHWS. Please contact your organization.