I certify that:

• I (or my dependent) receive the programs I listed.
• If I move I will give my internet company my new address within 30 days.
• If I no longer receive the government program(s) I listed, I will tell my internet company.
• I know that my household can only receive 1 ACP benefit.
• The information provided can be collected, used, shared, and retained by the FCC.
• I know that the ACP is a federal government subsidy and at the program’s conclusion my rate will go back to what it was before.
• All the answers provided are truthful.
• I know that willingly giving false information to get ACP benefits is punishable by law.
• I know that the ACP administrator may have to check whether I qualify occasionally.
• I am truthful about my location.