Online Application Form
Oregon Lifeline Program

Oregon Lifeline is a federal and state government program that provides a monthly discount on phone (up to $15.25) or broadband service (up to $19.25) for qualifying low-income Oregon households with participating service providers (see list below).

You may qualify if you receive one of the following benefits.

  • Supplemental Nutrition Assistance Program (SNAP),
  • Medicaid,
  • Supplemental Security Income (SSI),
  • Veterans or Survivors Pension,
  • Federal Public Housing Assistance (Section 8),
  • Total Household Income is at or below 135% of the Federal Poverty Guidelines,

Tribal Specific Programs

  • Tribal General Assistance,
  • Tribal Head Start,
  • Tribal Temporary Assistance for Needy Families (TANF), or
  • Tribal Food Distribution Program


Contact the Oregon Public Utility Commission

Phone hours: Monday - Friday, 9am - 4pm

(* indicates required field)

Applicant's Legal Name
(* First) (Middle) (* Last)
* Applicant's Social Security # * Applicant's Date of Birth:
(Format: 123-12-1234) (Format: 01/01/1975)
* Applicant's Service Provider:

Note: The below companies only offer the Oregon Lifeline discount in select areas.  Please call your company to find out if they offer the Oregon Lifeline discount where you live.  

AT&T Mobility: 1-800-377-9450
Hunter Communications: 541-772-9282
Spectrum: 1-800-941-7809
Viasat: 1-855-851-7419
Applicant's Home Address:
(* Street)    
(* City)    
(* State)
(* Zipcode)

* Do you live on federally-recognized tribal lands in Oregon?

Is this a temporary address?

Applicant's Mailing Address (if different than above):
(Choose Type)
* Applicant's Phone or Broadband Account Number for Lifeline Discount to be Applied Contact Phone Number (If Different than Phone Number for Lifeline Discount)
(Format: 123-123-1234) (Format 123-123-1234)
Note: If the account number has less than 10 digits, zero(s) will automatically be added at the end after you submit the application.
Applicant's Email Address (username@host.domain):
Please re-enter your Email Address
* How Does the Applicant Qualify for Oregon Lifeline?
Note: Send acceptable documentation to OPUC within 30 days of submitting this application
1-877-567-1977 (Fax) P.O. Box 1088
Salem, Or 97308-1088
If the applicant qualifies by income, please indicate the total number of household members, including applicant, with whom the applicant shares income and expenses. If applicant is only member of household, please enter 1.
Please completely READ and INITIAL each rule indicating that you understand and agree to comply with the following:
1. I understand that if I am approved as eligible, it may take 30 to 60 days for my service provider to apply the Oregon Lifeline benefit to my account.
2. 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 my service provider to release any required records for my Oregon Lifeline benefit.
3. I understand that my household can only get one Lifeline benefit.
4. I understand that if I break or violate the one-per-household rule, I will be de-enrolled from the Oregon Lifeline program.
5. I agree to let the PUC know within 30 days if:
  • I move.
  • I disconnected service.
  • I no longer qualify for the Oregon Lifeline benefit.
  • I receive more than one Oregon Lifeline benefit.
  • Another member of my household is also receiving the Oregon Lifeline benefit.
6. I understand that my Oregon Lifeline benefit may not be transferred or given to any other person.
7. I understand that I may be required to recertify my continued eligibility for the Oregon Lifeline benefit at any time and that, if I do not comply, my Oregon Lifeline benefits will stop.
8. I understand that Oregon Lifeline is a federal and state 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 Oregon Lifeline benefit.