Apply to ACP through Xfinity

Complete this form to apply to the Affordable

Connectivity Program (ACP) through Xfinity.

We’ll use the email address you provide to send

updates on your enrollment status. Once you’re
successfully enrolled in ACP through Xfinity (expect
3-5 business days), you’ll see your ACP benefit on
your next bill.

Not ready for ACP? Skip ACP enrollment and

continue to checkout

Do You have your National Verifier ID?

Chat
No

First name

Junior

Middle name (Optional)

Last name

Adames

Date of Birth

01/21/1980

Street address

1220 150TH ST,HAMMOND,IN,46327

Email address

laronda1012@gmail.com

Select one form of identity verification

Social Security number (last 4 digits)

Tribal ID number

Do you qualify for Lifeline or ACP through your child

or a dependent?

No, I qualify by myself

Yes, I qualify through my child or dependent

Are you or someone in your household in any of these

programs?

Check all that apply. You may be asked to submit

documents about the program(s) you select.

SNAP (supplemental nutrition assistance

program) or Food Stamps

Medicaid

Supplemental Security Income (SSI)

Federal Public Housing Assistance

Veterans Pension and Survivor Benefit

Programs

Federal Pell Grant in the current award year

Free and Reduced Price School Lunch or

Breakfast Program in the current school year

Enrollment at USDA Community Eligibility

Provision (CEP) School

Special Supplemental Nutrition Program for

Women, Infants, and Children (WIC)

Tribal Specific Program (only choose if you live

on Tribal Lands)

I do not participate in any of these programs

and want to qualify through income

Do you live on Tribal Land?

OFF

By submitting this form:

I give Comcast permission to share

necessary personal information with the
Universal Service Administrative Company
(USAC), the administrator of the federal
ACP, in order to request consideration for
the program and to administer the program.
This may include the information reflected
on this form, including first name, last name,
phone number, email address, date of birth,
and last four digits of social security number
or tribal ID; Xfinity account number and
service address. I understand that I will not
be able to participate in the ACP if I do not
consent to sharing this information.

Continue

Skip ACP enrollment and continue to checkout

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