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AFFORDABLE CONNECTIVITY PROGRAM SIGNUP FORM

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ACP Program Form

AFFORDABLE CONNECTIVITY PROGRAM

 

Enrollment Consent for Current Lifeline/Non-Lifeline Enrollees

Households currently participating in the Lifeline Program do not need to apply for the Affordable Connectivity Program (ACP) or submit new eligibility documentation if the household is already enrolled in the National Lifeline Accountability Database (NLAD). Current Lifeline enrollees, however, must still opt-in and give consent or affirmatively request enrollment in the ACP before receiving the ACP benefit. Qualifying consumers can participate in both the ACP and the Lifeline program, and may apply their ACP benefit to their Lifeline service or to a different service. Households NOT participating in the Lifeline Program must apply for enrollment for the Affordable Connectivity Program through the National Verifier. After receiving enrollment approval, the customer will contact the internet provider with consent to apply the ACP benefit to their internet service.

ENROLLEE INFORMATION

Account Owner (as it appears on customer account)
Account Owner (as it appears on customer account)
First
Last
Benefit Qualifying Name
Benefit Qualifying Name
First
Last
Service Address
Service Address
City
State/Province
Zip/Postal

PROGRAM DISCLOSURES

  • The ACP is a federal government program that reduces my broadband internet access service bill;
  • I may obtain ACP supported broadband service from any participating service provider of my choosing;
  • I may apply the ACP benefit to any broadband service offering of the participating provider at the same terms available to households that are not eligible for ACP supported service;
  • The provider may disconnect my ACP supported service after 90 consecutive days of non-payment;
  • I will be subject to the provider’s undiscounted rates and general terms and conditions if the ACP program ends, if I transfer my benefit to another provider but continues to receive service from the current provider or upon de-enrollment from the Affordable Connectivity Program;
  • The ACP is non-transferrable (to another consumer) and limited to one monthly internet discount per household;
  • The ACP allows me to obtain broadband internet access service supported by the ACP from any participating provider of my choosing and that I can transfer my ACP benefit to another provider at any time.
  • The ACP benefit will now be applied to my Kingdom Telephone service and will no longer be applied to the service with the transfer-out provider.
  • The result of the transfer out means, I may be subject to the transfer-out provider’s undiscounted rates, if I elect to maintain service with the transfer-out provider.

If you are having issues with your provider that involve the Affordable Connectivity Program (ACP) you may want to file an informal consumer complaint with the FCC. If your issue is a billing and service issue, the FCC will serve your complaint on your provider. Your provider has 30 days to send a response to your complaint. The FCC encourages you to contact your provider to attempt to resolve your issue prior to filing a complaint. To proceed with filing a complaint with the FCC, please go to consumercomplaints.fcc.gov or call the ACP helpline at 877-384-2575.

 

Delinquent households that have not paid their monthly service fee for more than 30 consecutive days, will have their service downgraded to the lowest available service tier.  They will remain at that service tier until their payments are current and they request to be returned to their original tier.

Having received and understand the disclosures above, I affirmatively consent to apply or transfer my Affordable Connectivity Program benefit to the internet service received from Kingdom Telephone Company.