Online Application Form
Oregon Telephone Assistance Program

The Oregon Public Utility Commission (PUC) manages the Oregon Telephone Assistance Program (OTAP), also known as Lifeline. If you have landline, wireless or broadband service with a participating company (see list below), and receive one of the following qualifying benefits, this federal and state government assistance program reduces your monthly bill upto $12.75.

  • Supplemental Nutrition Assistance Program; Food Stamps (SNAP)
  • Supplemental Security Income (SSI)
  • Medicaid

To apply for OTAP benefits:

  • Fill out the form below
  • Click the Submit button (by clicking the submit button you agree that you are electronically signing this online application)

Questions? Contact the PUC Monday through Friday from 9:00 a.m. to 4:00 p.m. at the following telephone numbers and e-mail address below:

Applicant's Name:
(* First) (Middle) (* Last)
   

* Name on Account:

Note: Applicant must have their name on the account. Please contact your company to have your name added to the bill. If your name is not on the bill you will NOT be able to submit this form.
 
Is your name on the bill?

 
* Applicant's Social Security # * Applicant's Date of Birth:
(Format: 123-12-1234) (Format: 01/01/1975)
     * Applicant's Phone/Account Number:
* Applicant's Company: (Format: 123-123-1234)

Note: List includes only participating companies. Some companies (e.g. MCI, Comcast, Verizon Wireless) do not participate.

Note: To receive OTAP you must have active service with a participating company.

Note: AT&T Mobility only offers the Oregon Lifeline benefit in select areas. Call 1-800-377-9450 to determine if AT&T offers the Oregon Lifeline benefit in your coverage area.

 
Applicant's Home Address:
(* Street)    
(* City)    
(* State)
(* Zipcode)

   
     
Applicant's Mailing Address:
(Choose Type)
(Street)   
(City)   
(State)
(Zipcode)   
 
Applicant's Email Address (username@host.domain):
(Format: john.doe@gmail.com)
Please re-enter your Email Address
Please completely READ and INITIAL each rule indicating that you understand and agree to comply with the following:
I understand that completing this application does not immediately approve me for the Oregon Lifeline benefit. I will be notified in writing of my application status.
 
I understand it may take 30-90 days for the company to apply the Oregon Lifeline benefit to my account.
 
I give the Oregon Public Utility Commission (PUC), the Federal Communication Commission, and the Universal Service Administrative Company authority to obtain or review any required records needed to confirm my statements and to confirm that I qualify for the Oregon Lifeline benefit. I also authorize the company to release any required records for my Oregon Lifeline benefit.
 
I am head of household and no one else in my household receives landline or wireless OTAP/Lifeline service.
 
I understand that the Oregon Lifeline benefit is only allowed for ONE ACCOUNT PER HOUSEHOLD
 
  • A household is defined as any persons who live together at the same address and share income and expenses.
I understand that if I break or violate the one-per-household rule I will no longer qualify for the Oregon Lifeline benefit.
 
I agree to let the PUC know within 30 days if:
 
  • I no longer qualify for the Oregon Lifeline benefit
  • I receive more than one Oregon Lifeline benefit
  • I disconnected service with my company
  • Another member of my household is also receiving the Oregon Lifeline benefit
I understand that I have 30 days to notify the PUC if I no longer qualify for the Oregon Lifeline benefit or I may be removed from the program.
 
I agree to notify the PUC of address changes within 30 days of moving.
 
I understand that my Oregon Lifeline benefit may not be transfered or given to any other person.
 
I understand that I may be required to confirm that I still qualify for the Oregon Lifeline benefit at any time and that, if I do not comply, my Oregon Lifeline benefits will stop.
 
I understand that Oregon Lifeline is a state and federal benefit and willfully making false statements or providing false or fraudulent documents to obtain the benefit is punishable by law and can result in fines, imprisonment, disqualification or being permanently removed from the program.
 
 

By submitting this application I certify under penalty of perjury that the information contained in this application is true and correct and that I meet the eligibility criteria for the OTAP/Lifeline benefit.

     
   

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