Pendleton

Spruce Knob Seneca Rocks Telephone, Inc Lifeline Notice

NOTICE

Lifeline

Spruce Knob Seneca Rocks Telephone, Inc. (SKSRT) participates in the federal Link-Up America and Lifeline Assistance programs which are available to qualifying low-income subscribers. Lifeline Assistance enables low-income subscribers to receive flat-rate support of $9.25 per line for service. Only eligible consumers may enroll in the program. Each state has its own guidelines to qualify. The application and qualification process differs by state and sometimes by individual phone company.

How much can I save on my phone bill?

You will save $9.25 on your basic monthly bill if you qualify. These benefits apply to your local telephone service charges that you purchase as a flat rate service. These benefits will also cover your subscriber line charge.

How do I know if I am eligible?

To be eligible, a subscriber must either have an income that is at or below 135{4ceb532c6f579389df471c6c1e832caf2346b74dc60fcbf6aabd4d29df3baf9c} of the Federal Low Income Program or participate in one of the following assistance programs: Medicaid; Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps; Supplemental Security Income (SSI); Federal Public Housing Assistance (Section 8); Low-Income Home Energy Assistance Program; Temporary Assistance to Needy Families; or the National School Lunch Program’s free lunch program.

Program-based eligibility:

• Federal Public Hous- ing Assistance/Section 8

• Supplemental Nutri- tion Assistance Pro- gram (SNAP), formerly

known as Food Stamps

• Low Income Home En- ergy Assistance Pro- gram (LIHEAP)

• Medicaid

• Supplemental Security Income (SSI)

• National School Lunch (free program only)

•West Virginia Works a.k.a. Temporary As- sistance for Needy Families (TANF)

Income-based eligibility:

•Total household income

at or below 135{4ceb532c6f579389df471c6c1e832caf2346b74dc60fcbf6aabd4d29df3baf9c} of the

Federal Poverty

Guidelines

Are there any restriction?

The program is limited to one benefit per household, consisting of either wireline or wireless service. The name on the application must match the name of the household member participating in the eligible program (with the exception of the National School Lunch free program).

What information do I need to provide to receive Lifeline benefits?

You will be asked to provide proof of your eligibility by providing a form signed under penalty of perjury that you receive benefits from or a copy of any dated document which verifies your participation in one of the qualifying programs listed above. Documentation can be obtained through your social worker or from the West Virginia Department of Health and Human Resources (DHHR). Proof of total household income may be required for income-based qualification. Your Lifeline benefits will take effect when proof of eligibility is received.

How do I apply?

Certification forms may be obtained from the West Virginia Department of Health and Human Resources. Those claiming to qualify based on income must present acceptable documentation of the household income. Acceptable documentation includes: the prior year’s tax return, current income statement from an employer or paycheck stub, a Social Security statement of benefits, a Veterans Administration statement of benefits, a retirement/pension statement of benefits, an Unemployment/Workmen’s Compensation statement of benefits, federal or tribal notice letter of participation in General Assistance, a divorce decree, child support, or other official document. The program is limited to one benefit per household, consisting of either wireline or wireless service. Consumers who willfully make false statements in order to obtain program benefits can be punished with a fine or imprisonment or barred from the program.

How do I continue to receive Lifeline benefits?

Eligibility is reviewed annually. Your benefits will be discontinued when you no longer meet the eligibility requirements according to the DHHR or when proof of eligibility is not received. 1c