What is asked in an Assurance Wireless Application?

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You can go directly to the Assurance Wireless page, or continue reading to learn about their application:

We’ve had quite a few people ask us what’s in the Assurance Wireless Application that one must fill out to order a government cell phone. It’s a simple form that may literally take you all of one minute to complete. Here are the various elements of the one page application from Assurance Wireless:

NOTE: You can choose to complete Section B or Section C. Only complete one.

Section A Personal Information

This consists of your name, home telephone number (will become your application ID), street address (PO Box not accepted), city, state and zip.

Section B: Program-Based Eligibility

If you are qualifying for your phone based upon your participation in a government assistance program, mark the the checkbox corresponding to the program in this section. There is no need to provide program documentation.

Section C: Income-based Eligibility

If you are qualifying based upon your low-income, you must complete this short section. Simply check your household size, and the total income of all adult persons residing in your home.

Note that you will have to attach proof of income. This can be your prior year’s state or federal income tax return, three consecutive months of payroll stubs, or benefit statements from wherever you obtain your income.

Section D: Signature

This is of course where you sign the Assurance Wireless Application. But it’s more than just a signature. You are certifying that you are telling the truth. Don’t cheat. Here is the exact wording you are agreeing to by signing the application:

By signing below, I certify under penalty of perjury that the information contained within this application is true and correct and that I am head of my household. I also acknowledge that providing false or fraudulent documentation in order to receive assistance is punishable by law and the penalties of perjury include monetary fines and potential imprisonment.

I understand that completion of this application does not constitute immediate approval for Assurance Wireless service. I authorize Assurance Wireless or its duly appointed representative to access any records (including financial records) required to verify my statements herein and to confirm my eligibility for Assurance Wireless service. I authorize social service agency representatives to discuss with and/or provide information to Assurance Wireless verifying my participation in public assistance programs that qualify me for Assurance Wireless service. I also authorize Assurance Wireless to release any records (including financial records) required for the administration of Assurance Wireless service.

I understand that I may be required to verify my continued eligibility for Assurance Wireless service at any time. Failure to verify eligibility will result in termination of Assurance Wireless service. In the future, if my total household income exceeds 135% of the federal poverty guidelines, or I am no longer eligible to receive benefits from at least one of the qualifying public assistance programs listed above, I will notify Assurance Wireless within five (5) days.

I understand that Lifeline Assistance is only available for one landline or wireless phone per household. If I currently have a Lifeline plan with a different phone service provider, I will notify my current provider when I am approved for Assurance Wireless service.

To apply to Assurance Wireless, go to the Assurance Wireless page for contact information. To check what other vendors you can get a phone from in your state, check our free phones by states page. If you are completely confused, start here.

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  1. If you are going to ask "how do I get a cell phone?" go here instead.
  2. If you are going to ask "how do I get a replacement phone," go here instead
  3. We are not your cell phone company. All technical questions should be asked of your vendor.
  4. Your comments are moderated, and we will manually approve those worth publishing within 24 hours.


  1. alma rodriguez says

    I lost my phone and someone is using it how can I cancel my phone and number can I get a new one again

  2. Richard says


    I have done my annual confirmation and answered all 7 questions twice over the past two months. They now have called again, Is this something that needs to be done every month?


  3. Nicole cleary says

    I applied for the assurance phone well over three months ago so why havent i heard anything back yet.

  4. marielle grass singing says

    please email me an application for inexpensive or free internet service or cable service…thank you.

  5. Eugene says

    I have requested an application form. They told me i will receive an application within 3 business days. As of right now, I’m waiting for 10 days, and i have not received it yet. Now i know what is going to happen next. I will have to give them a call and they will probably tell me, that I have never asked for application…

  6. R. Walters says

    I have faxed my application AND proof from my SSI award letter, Copy of my Medicaid card and SSI monthly statement of income letter 5 TIMES. Each time I get denied because I have not submitted proof of eligibility, REALLY??? Very frustrated!! This company DOES NOT reply to emails, there is no one to talk to even though on my fifth attempt to get approved I asked them to contact me.

  7. Robin D Stokes says

    How can I become a Agent for assurance wireless. My cell number is 224 645 ****.

    I live in lancaster ca area.

  8. Marwan says

    I applied many times , I’ve been in the us 4 months ago , don’t work I have food stamp and assistance, have kids my application number pin ******. after I email you 100 times and you said you send my application and I received nothing , after all you send me the application I filled it copy it , also paid $10 from my pocket to fax it and at the END I received a letter saying my application denied because of the signature didn’t match my name really? do any body reviewing these application have knowledge that some of the refugees speak different language and maybe they sign their name in their mother language really? who need it more than me ?
    thank you very much
    I wait for you r decision to review it again please

  9. gary martin says

    hi i apply for free assruance cell phone she i was apove what kine of plone thank you i well get my new phone thre to five day

  10. Debra A. Velky says

    Genesee ACE Employment (Restoration Society Inc.) is requesting 100 Assurance Wireless Cell Phone Applications to provide for our customers. Please let me know if you can help me with this. We are a non-profit organization that services individuals that have a mental health diagnosis, we also have customers that are disabled. Thank you in advance for your assistance.

  11. Lawrence W. Lee Jr. says

    Am trying to find out status on application, filed twice. Application number is 195668629, PIN number is ********. The application number was given by a supervisor named Marcella based in
    South America

    This is very frustrating as this is ny fourth or fifth time trying to get an answer.
    Thank you

  12. jessica henry says

    I applied for a government cell phone at a tent site and later received a letter saying that I didn’t have any sources on file that would make me eligible but I had provided the lady with my snap benefits card.could someone please explain to me why this happen.

  13. carol Ward says

    I wish to have a free gov phone. I am on Social Security, On section 8 housing and receive food stamps. Also like info on internet.

  14. Alicia Seffl says

    I lost my phone could you send me a new one I get snap again from the state of mn I don’t have a phone right now could you mail me a new one with a new number? Thanks Alicia Seffl
    my old number was 612-251-****

  15. Eva Washington says

    I’m trying to get an application sent to me for my Aunt, where can I get one. She’s 81 years old on Medicare and Medicade and she is on a fixed income.

    Thank you

  16. sue yanez says

    ive applied for homeless people in a shelter. now months later still no response. i think they of all should get a free phone.

  17. luis beato morillo says

    tengo desde el 24 de octubres esperando un telefono 347 778 **** ———————–81264079 por favor digames ke ha pasado con mi envois del telefono

    • Jason says

      go to assurancewireless.com and fill the application online with your parents info and wait for the approval letter

  18. David Walters says

    I have been atempting to get a lifeline phone thru assurance since the end of june 2014. I have sent mailed 4 applications with all the documents included ( snap paperwork and copies of food card) and I have Faxed the same things to the fax #1-877-7382-3018 . I keep getting denied letters that say I am not in the Texas database. But when I call the Lite-Up Texas # 1-866-454-8387 they say I am in the database. I just keep getting new applications with the denied letters and the prepaid envelopes the come with them are not going to the same place (3 different addresses) and The Application has a different address on it. They just keep telling me to wait. I AM GETTING REALLY SICK OF THEM i CAN NOT EVEN TRY ANOTHER CARRIER BECAUSE i AM IN THEIR SYSTEM AS GETTING SERVICED BY THEM.

  19. Aida Santa says

    I’m trying to get an application for my father-in-law, NOT for myself. Where can I get one?

    He’s elderly (87 years old, on medicare, and is also applying for Medicaid in order to get a home care attendant. He’s also a vet of the Korean War).

    Thank you for your assistance.

  20. Carmen Muniz says

    I’ve tried al the phone numbers but they don’t answer my questions.one is about my pin # to access a recertification. My address have changed and I need to know how to fill the form and be on time.

    • Jason says

      Carmen the pin # is the number that you put on your application at the very first time and it has to be a 6 digit number sometimes 10 digits. Your account have a expiration date, you need to go through the process over the phone or online before the expiration date, If you have questions call 888-321-5880
      and if you need to complete your annual certification call 888-653-9262 answer 7 questions.

  21. Lynette says

    I have a lifeline landline which I use nightly to talk to my mom and daughter because I live alone and I am the victim of domestic violence. But I also need a cell phone just to have with me in case of emergency out in my car.

  22. CHARLES PRICE says


    • Free Government Cell Phones says

      If you already have a Lifeline phone, why are you looking for another one? You are only allowed one.

    • Jason says

      Yes, you can but assurance wireless only work wit virgin mobile PayLo phones, you can find them any retail store, like radioshack, 7eleven, target, etc, as soon as you got it you only have to swich handsents calling to assurance wireless customer service 888-321-5880 and your service will be swich to the new phone

  23. Judi Dilean Morris says

    I would like one of you phones so I can have a way for my Dr & parents can get a hold of me when they need to. Please send me one

  24. Ralph McFadden says

    it is less stress buying your own phone–nothing is free, oh I stand corrected Cancer and HIV are free anyone want them??? For me it has been three months waiting for the application.

  25. Isabel T says

    I applied for this phone 2months ago & never received it. I applied at a stand where they had info about it. When I call they ask for my # then hang up on me bcus I don’t have it? Now What????

  26. D. S.Williams says

    how can a free android phone, with my eyes everything on it is much largerger to easy accessable ,so where can i get one. i’vehave everything and are you truly sure it’s free ?

  27. renna waters- adams says

    to whom may concern i will like to apply for a cell phone im on the gov. program how do i apply thank you.

  28. says

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    you’ve put in writing this blog. I am hoping to view the same high-grade content by you later on as well. In fact, your creative writing abilities has encouraged me to get my very own site now πŸ˜‰

  29. Free Government Cell Phones says

    There is an application form. As we’ve said, over and over, click the link in the article which will bring you to our Assurance Wireless page. On that page is all the contact information for Assurance. Website, phone number…

  30. Andraya Gleave says

    I receive assistance from the state for food and medical, I would qualify correct? If so how can I receive it the soonest?

  31. David Reiling says

    How do I prove my low incom when I havent had one for years, Ive been on the road alot trying to find work but never made enough to even fill out incom taxes. im hoping for work now thats where the phone comes in handy. HELP!

  32. chris martin says

    I do recieve food stamps from the state and just learned I may be eligible for a free phone..will you please send ( email) me an application..thank you so much for your help, chris

  33. Kimberly Lehto says

    I sent my application out over a month ago and I haven’t heard not a word and…..no phone. Is there a way I can check my government cell phone statis? ThankYou.i look forward to a call or email letting me know .:)

  34. Fernando Marzan says

    I would like to fill out an application for an assurance wireless and I do beleive that I can receive the benefits, according to the cualification requirements in Puerto Rico.

  35. Misty Mosley says

    I would like an application from safe link and assurance wireless please, I get food stamps and low income so please send it to 4537 PrincesSprings

  36. Annette Campbell says

    I have had so much trouble getting a new phone from Assurance Wireless, even though I sent in a copy of my medicaid card and the application over a month ago. I tried the month before last through an employee from the company near the mall downtown and I never heard back or got my phone at all! I have been waiting for 3 months for my free phone and everytime I call they say it is “under review”. I don’t get how it can be “under review” for a month when I sent them all the information they need to approve my account! I am pretty upset at this point and feel like there is something weird going on with my account…..like someone else using my information, or something like that! Why else wouldn’t I get my phone for 3 months, and even when I sign up through an employee from their company? Any suggestions on how to get my free phone? Thanks, Annette

  37. lee todd says

    I have been sleeping in my car now for 7 months. The only address I have is a PO Box used for letters from UNEMPLOYMENT.
    But I cannot QUALIFY for the free cell -phone program because I have only a PO Box. No house, no apartment, only my “two bedroom one toilet” car.
    Ever tried to fill out a job application WITHOUT a PHONE NUMBER??
    The whirlpool continues DOWNWARD………………………………………..

  38. Free Government Cell Phones says

    Dear everyone looking for an application. The article we wrote above tells you how to do it. We even boxed the information with a gray background so you won’t miss it. Please read the article all the way to the end.

  39. maryann depoalo says

    There is no way to get an application in any websites. It says sign. But where there is no where to sign

    • Kerri says

      call- 1-888-898-4888 I just did it today 1-7-2013 . Went well they are sending me the paperwork.
      Hope this helps!

  40. tim says

    To everyone who is having problems finding the application…this is how GOVERNMENT WORKS. Get used to it.

    Wait til Obamacare kicks in and the frustration you’ve experiencing now happens at your doctor’s office, or emergency room.

  41. Kevin says

    Wow I was going to apply as a joke because I think its absolutely pathetic that hard working people like myself have to help support programs like this. Already 12+ million people with phones??!! WOW. But this website is impossible and every link really does just take you back and forth to various pages on this website lol. Atleast they are making it hard for lazy moochers to get more free shit from us. My God

  42. Concerned says

    For the people looking for a free phone, why do you need a free phone to contact 911 when 911 will work on a non working phone. Also stop complaining about needing a phone when all of you are on the internet.

  43. amicka mansfield says

    ii would like to see bout my app. i called over a wk&a half for a app. to get a free phone through your gov. program thank you

  44. sandy says


    I would like to check the status of my application but I don’t know how. I have the enrolment number.
    Can anybody please help me?

  45. Brad Rice says

    Also since information is nearly impossible to find, heads up you need a printer to print out this application (or save it to a disc and take to a Printing shop or wherever). They also require you to mail in income verification (if your claiming eligibility on income base or a SSI award letter or proof of benefit (if it’s program eligibility based). It’s one or the other either your income or your award letter(s). cheers

  46. Brad Rice says

    To the person who thinks they are linking the application you are only linking to a different part of this site that doesn’t have the application. Wake up! try clicking the link and see what happens (i know that’s some really rocket science like troubleshooting. Maybe if you put a link that acually went to the Assurance Wireless website and application rather than a link taking you in circles on this single site people could actually apply for a phone. Wouldn’t that be swell.

    • Free Government Cell Phones says

      The page I gave you the link shows the Assurance Wireless address, toll free phone number, email address, and website address. I can’t hold your hand more than that. Just put on your glasses and look for it. All the info is at the bottom of the page I gave you.

      Having an application with no where to send it is useless. Start with the information on that page.

  47. Free Government Cell Phones says

    To all who cannot find the application. we have a big gray box at the end of the article, above, that you are missing. Go up and read it and click as it says. Go up and read it and click as it says. Here’s what it says:

    To apply to Assurance Wireless, go to the Assurance Wireless page for contact information.

    So, if you follow directions, you click the words “Assurance Wireless” and that brings you to our page that has all the Assurance Wireless contact information (look for the contact info in another highlighted box you should not be able to miss). You can then call them or go to their website and apply online. It’s very simple.

  48. mary says

    I have never had such a difficult time finding an ONLINE APPKLICATIION, that is offered from companies. WHERE IS YOURS???? Im glad Im not the only one.

  49. Paula Brenick says

    My question is this. I live with my daughter because I can’t afford to live by myself. I get approximately $750 after deductions a month. My daughter is the head of her household, but I am the only person considered in my household. I want to know that even though I live with her, am I eleigble for a free phone? I file separate income taxes and provide for my own self with the $750 a month. It would really help me to receive a free phone. Other than living with her, I provide for myself with my income.

  50. Sandy says

    i cannot find the friggin application to save my life!!!!!!!! link please…and not one that takes me in more circles!!!!!!!!!!!!!!

  51. amy breedlove says

    Hi yes im on food stapms and i also go there DvR beaucse i have a learing didbillty and there helping me look for a job right now i really could us a phone so pople can call me for jobs i hope i can get one i do get food stamps evey mouth thanks can you please send me the application for the phone please thank you amy

  52. janet smith says

    where is the application? Please e me one as I don’t see a link to it. I AM NOT THE ONLY ONE WITH THIS PROBLEM. some web improvements needed.

  53. Brian Linnell says

    I need to fill out an application , this is kind of ridiculous how hard it is just to try and fill out an application!

  54. Nikita Gardner says

    I did the application, but it wont let me sign the bottom or submit it. What should I do?

  55. kidada houston says

    i am on foodstamps and i live in a rooming house apartment 1. I would like to apply for a free phone!

  56. William Barnes says

    to:Kentukywoman2:The only thing you know of Colombia is that and by who??? To you who are the world’s largest drugaddicts, learn about Colombia ignorant who just says what you hears,its colombia and Bogota,go to school y learn geography first

  57. kentuckywoman2 says

    DO NOT GET A PHONE FROM THESE PEOPLE!!!!! I’ve got a phone from them that doesn’t work half the time, doesn’t keep a battery charge, and basically isn’t reliable and I can’t use it. I’ve been trying to get a replacement for the past week or so. The first woman I spoke with said they didn’t have any phones in stock and to call back in five days. She gave me a ticket number. Fine. I’ve waited the five days.

    Tonight I call back and spoke to some guy who didn’t even check to see if there were any phones available. All he was concerned about was that I change my ACCOUNT PIN NUMBER, which I was told by the original sales person would NEVER change – and get this – he wanted me to change it to MY BIRTHDAY, OR MY SOCIAL SECURITY NUMBER.

    I asked to speak to his supervisor and he said “NO.” That’s right, he refused to let me speak with a supervisor. I asked for his name and he said it was Chris. I asked him if he had a badge or employee number and he said, “NO.” So I asked him if I called back tomorrow and spoke to someone in the main office and said that Chris refused to let me speak with his supervisor, would they know who I was talking about. He said “No”, because they have call numbers all over the world. I asked where he was calling from and he said BOGATA, COLUMBIA.


    SOMETHING’S NOT RIGHT. I think I’m cancelling my service with them and going with another company – AFTER I report them to my State Attorney General.

    These people must obviously be crooks. I know they’re stealing from the government by providing phones that don’t work. That’s fraud itself.

  58. Julie Banister says

    I received the phone but not the acceptance letter for my pin number. How can I get that? I can’t use the phone.

  59. kentuckywoman2 says

    This information is INCORRECT. First of all, when you call Assurance Wireless, be prepared for the android voice menu where they want you to tell them your address – but of course, being an android they don’t understand you. After about 10 minutes of waiting to be transferred to a live human being, you’ll have just the opposite problem – you probably won’t be able to understand them because they’re foreign. Good luck with that. After a few minutes of trying to ask a question in English that the live representative doesn’t quite “get”, the bottom line is that they’ll tell you they’ll mail you an application, even though you keep telling them that you can download and print one off the website. Forget about submitting an ONLINE application- THAT’S ERRONEOUS. Assurance doesn’t have online submission, even though it says it does here. Plus, while here it says you don’t have to submit documentation for program eligibility, Assurance says you do – and especially your social security number. That last one kind of gets me a bit because it made me very uncomfortable to have some foreign guy not even in the U.S. ask me repeatedly for my Social Security number. I’m not sure if I’m going to follow through on this or not. I think I’ll call my State Atty General’s office before I do. It seems to me that there’s something just not right about this whole thing – websites that tell you different things, foreign service reps in another country asking for my social security number and above all, the representative I spoke with said THEY WERE A GOVERNMENT AGENCY. I don’t know that I believe that. What U.S. government agency works out of a foreign country to give U.S. citizens a free cell phone? You call and decide for yourself. I’m not convinced that if I give them my SS # I won’t end up a victim of identity theft.

  60. Margaritta Wiggins says

    I received my letter dated December 19, 2011, stateing my account information
    but I never receved a telephone. I keep calling and I was tood I will get one in ten days.

  61. BILL says


    • Free Government Cell Phones says

      We don’t have the application here. We are merely an information site, you need to go to Assurance Wireless site. That’s why we have several links to our page on Assurance Wireless right here on this page — look up and you’ll see them. Then, follow the link to our Assurance Wireless page, and all their contact info is on the bottom of that page.

  62. Cindy Copley says

    Would like to get the free phone but it seems imposible to find out the imfo to do it and also get free min.

    • Free Government Cell Phones says

      Hint: you’re on a site that is all about this. And this article you’ve just read gives the link to the page with the contact information on it at the end. It’s all here.

  63. cheryl says

    i need an application for a free cell phone and cannot find it on the site.please provide me so i can submit.thank-you!

    • Free Government Cell Phones says

      To everyone looking for an Assurance Wireless application, please read the article above. You’ll see a link in a highlighted box — it’s pretty obvious.

    • Free Government Cell Phones says

      There is a link to the Assurance Wireless contact information at the end of the article above. Click it and you’ll go to a page with phone numbers, emails and website URL at the bottom.

  64. Ines M Veliz says

    Definitivamente, la intencion de Obama pudo haber sido muy buena con esta variante y otras a favor de la ciudadania, pero cuando comienzan a procesarse y aparecen las trabas que intermediarios inescrupulosos introducen, a uno le dan deseos de decir: Senor Obama, si con esto va a ganar mi voto, pues sepa que lo tiene perdido por no elegir correctamente a las personas que van a poner en practica sus leyes.
    Y solo voy a hacer una pregunta:
    – Por que cuando se aplica por los Beneficios que son requisitos para optar por un telefono, no esta comprendida la opcion del telefono y asi este llega junto a el resto del paquete que el gobierno le asigne a cada solicitante?
    Es que ahorita hay que tener una oficina en la casa para poder procesar cualquier solicitud. O hay que ser muy ignorante para no saber que una maquina de fax cuesta y el servicio tambien? Que los sellos del correo cuestan dinero y que quien pide ayuda es porque no tiene o no le alcanza para vivir con lo que recibe?
    Vamos, es decir, te doy, pero te lo pongo bien dificil para que te arrepientas y que te rindas por cansancio. Asi queda como que el gobierno ayuda y la gente no lo sabe aprovechar.
    Inteligentes que se hacen.

  65. r goodpaster says

    Are there only certain areas in Indiana that can get these phones or do you have to live in a certain part of the state?

  66. ashleigh says

    i think it is a good plan for lower income people but what about the people that dont qualify for food stamps ssi or any of the other? how is it fair what happend to equal opprotunity? the government is pissing on the ones who really need it the most if you think about it the people with ssi can afford a regular cell phone because they are on low income based housing that usually is around 100 they have all that other free money floating around but the government wants to continue helping them when they should try to help the ones really in need like myself…i have applied all over town and nothing i have applied for foodstamps and i dont qualify medicaide can get that either and unemployment and guess what still nothing…what am i supposed to do about employers trying to contact me? i have no phone no car no home and cant afford either of them but i cant even qualify for a government cellphone to recieve calls from possible employers thats pretty sad if you ask me so you people on ssi an foodstamps should feel lucky because i dont but who in indiana really cares? nobody

  67. Ida-Sakinah says

    I know a older gentleman who qualifies for the phone but has no physical address he gets his mail at my house. The Safelink and Assurance applications say that you have to use a physical address. I already receive this service and they say one phone per household. Is there anything we can do or is he just stuck?? Mind you he doesn’t live with me he just gets his mail there- they also say no P.O Boxes either and he doesn’t have funds to pay for that anyway. Thanks for your response via email

  68. elizabeth says

    i live in alabama and i would like to know if i can get a free phone becuase when i try it tells me i cant becuasae i live in alabama

  69. Amanda Allen says

    Where do I go to so I can sign up for the assurance wireless “program based” cell phone. I see alot of information but no link to click on to sign up??

  70. Dannessa T says

    Can I email my application and docs in for this offer? The fax # they have listed won’t work. Keeps giving me a no answer.

  71. Teresa says

    where do i find the application for the phone through Assurance? I’m not sure if I just keep overlooking the link please help.

  72. says

    I see that this ad implies that because I receive General Relief and food stamps from Los Angeles county, that possibly I may qualify for a free cell phone. I do not see that residents of California have access to these programs. Do we? Since I am homeless I use the address of the Government building where I signed up for General Relief. That address is [redacted].
    my current telephone number is [redacted]. Thank you.

    Could someone send me an email to inform me if in fact I do qualify for the Assurance Wireless program.

    • Free Government Cell Phones says

      We’ve redacted your comment to remove your personal information, as that’s not wise to have on a public page.

      We’re sorry, but California is not yet part of the Lifeline program for wireless cell phones.

  73. chris reid says

    I don’t understand how to apply…i wanna get the phone and minutes…anyone know what I have to do? Please send me information…i want to join

  74. COLLEEN LUFT says