This Letter Contains Important Information About Your Phone Service

Month [ ], 2014

SUBSCRIBER NAME

SUBSCRIBER ADDRESS

Dear SUBSCRIBER NAME:

THIS LETTER CONTAINS IMPORTANT INFORMATION ABOUT YOUR PHONE SERVICE.

According to our records, you currently receive a Lifeline Program discount on phone service from the following company:

[MARKETING NAME OF ETC] [SUBSCRIBER PHONE NUMBER]

The Lifeline Program is a U.S. government benefit program that is available to qualifying consumers. The Federal Communications Commission’s (FCC’s or Commission’s) rules limit the Lifeline benefit to one individual per household. A “household” is defined as individuals who live together as one economic unit. An “economic unit” consists of individuals who share income and expenses.

Our records indicate that in addition to you, there is/are other person(s) at this address that is/are also receiving Lifeline Program discounts on either home telephone service and/or wireless telephone service. If you live at an address with another adult(s) who shares income and expenses with you and also receives a Lifeline Program discount, you and the other members of your household must decide who will retain the Lifeline Program benefit for the household. The person who will retain the Lifeline Program benefit for the household should complete a household worksheet and return it to [MARKETING NAME of ETC].

In order to determine whether everyone who receives Lifeline Program discounts at this address is part of the same household, you must answer certain questions found in the attached household worksheet. The other individual(s) who reside at this address and are receiving Lifeline Program discounts will also receive a letter asking them to respond to the same questions. Depending on the responses received, one or more Lifeline Program recipients at this address may be de-enrolled from the Lifeline Program.

Please review the information below to determine whether there are multiple households at your address. Only one household worksheet per household is permitted. Please be advised that providing false information on the household worksheet may result in the loss of the Lifeline Program benefit and possible criminal penalties. In addition, failure to respond to this request will result in de-enrollment from the Lifeline Program.

How to Respond:

To maintain your Lifeline Program benefit for your household, you must provide the requested information within 30 days from the date of this letter. You may submit your response by [METHOD TO BE PROVIDED BY EACH ETC]. If you have any questions about your Lifeline Program-supported service, please contact [MARKETING NAME OF ETC].