Enrollment Recording - Texas English

Pre-recording explanation

Mr/Ms [Applicant's name], to complete the application I will be conducting a recording to confirm and have on record, that you are requesting the Lifeline Benefit through [Brand Name]. During the recording, I will be asking your personal information and read the applicable disclosure statements.

Please only provide acceptable responses to create a clear recording and direct answers pertaining to the information being asked. If thequestion is answerable by YES or NO, kindly just respond “YES” if you agree. Otherwise, just respond “NO.”

We will begin the recording now

Recording

Today’s date is [date].

Mr./Ms. [Applicant's name], your answers to the questions that will be asked are provided under penalty of perjury therefore you must provide true and correct answers. Do I have your permission to record the confirmation of your personal information?

[When Application is not yet created – Voice Recording Pre-Persistence:

This is the recording for [Brand Name]

[When Application is already created – Voice Recording Post-Persistence:

This is the recording for [Brand Name] Enrollment ID # [Enrollment Number]

1. Could you please confirm your complete name to me? [Applicant's name].
2. Could you please confirm your complete address? [Applicant's address].

3. Could you please confirm your Date of Birth? [Applicant's DOB].

4. Could you confirm the last four digits of your SSN? [Applicant's SSN last 4]
5. You applied for the service under [Income/Program Participation], is this correct? (Customer will answer YES or NO).
6. And the plan assigned is Plan [plan description], correct? (Customer will answer YES or NO)

Thank you Mr./Mrs. [Applicant's name],  let me tell you that:

This service is supported by LifeLine. Lifeline is a federal benefit that makes monthly telephone and broadband service more affordable for eligible households. Your household may receive the Lifeline benefit for telephone service OR broadband service, but not both. For Lifeline telephone service, your household may receive the Lifeline benefit for one mobile OR one fixed home telephone service, but not both. For Lifeline broadband service, your household may receive the Lifeline benefit for one mobile broadband OR one fixed broadband service, but not both. Your household may not receive the Lifeline benefit from more than one service provider. For the purpose of Lifeline, a household is an individual or any group of individuals who live together at the same address and share income or expenses. Lifeline is a non-transferable benefit. You may not transfer your Lifeline benefit to another person, even if he or she is eligible. You will lose your Lifeline benefit and may be prosecuted by the United States government if you violate the one-per-household rule or otherwise make false statements to receive the Lifeline benefit.

Mr./Mrs. [Applicant's name], now I need you to answer “Yes” or “No” to the following terms and conditions to finish the recording.

Do you certify under penalty of perjury that:

1) You (or your dependent or other person in your household) currently get benefits from the government program(s) listed on this form or my annual household income is 135% or less than the Federal Poverty Guidelines (the amount listed in the Federal Poverty Guidelines table on this form). (Customer will answer YES or NO)

2) You understand that you must notify your service provider within 30 days of your new address if you move.

3) You understand that you must notify your service provider within 30 days if for any reason you no longer satisfy the criteria for receiving Lifeline benefits including:

(a) You, or the eligible person in your household, no longer meet the program or income eligibility criteria or

(b) your household receives more than one Lifeline discounted service. (Customer will answer YES or NO)

4) You acknowledge that your household can only receive one Lifeline Program benefit and, to the best of your knowledge, your household is not receiving more than one Lifeline Program benefit (i.e., only receiving a benefit for one home phone service or for one mobile phone service, but not both). (Customer will answer YES or NO)

5) You agree that your service provider can give the Lifeline Program administrator all of the information giving on this form. You understand that this information is meant to help run the Lifeline Program and that if you do not let them give it to the Administrator, you will not be able to get the Lifeline benefits.

(Customer will answer YES or NO)

6) All the answers and agreements that you provided on this form are true and correct to the best of my knowledge.

(Customer will answer YES or NO)

7) You acknowledge that willingly making false statements or fraudulent information to get Lifeline Program benefits is punishable by law and can result in fines, jail time, de-enrollment, or being barred from the program.

(Customer will answer YES or NO)

8) You may be required to recertify your continued eligibility at any time and failure to recertify your eligibility for the Lifeline Program will result in your removal from the Lifeline Program and termination of your Lifeline benefit.

(Customer will answer YES or NO)

9) You were truthful about whether or not you are a resident of Tribal lands, as defined in section 2 of this form. (Customer will answer YES or NO)

10) You authorize [Brand Name] or its duly appointed representative to: (1) access any records required to verify your statements herein; (2) to confirm your continued eligibility for Lifeline assistance; (3) to update your address to proper mailing address format; (4) to provide your name, telephone number, and address to the Universal Service Administrative Company (USAC) (the administrator of the program) and/or its agents for the purpose of verifying that I do not receive more than one Lifeline benefit; and (5) authorize social service agency representatives to discuss with and/or provide information to [Brand Name] verifying my participation in benefit programs that qualify me for Lifeline assistance.

(Customer will answer YES or NO)

11) You certify that your household is receiving only one Lifeline discount. You understand that violation of the one-per-household requirement is against the Federal Communication Commission’s rules and may result in you losing my Lifeline benefits, and potentially, prosecution by the United States government. You certify under penalty of perjury that your household receives a qualified benefit or your household has income at or below program guidelines and that your presented documentation that accurately represents your household income or participation in a qualified benefit program. Your certify that the information you have provided in this application is true and correct and you agree to participate in the Texas Lifeline program should you be eligible. You understand that the information provided is subject to audit and investigation by the Public Utility Commission of Texas. (Customer will answer YES or NO)

Thank you! We have finished the recording.

Thank you! Please allow me to place you on hold while I upload this recording to your enrollment.