Frontier New York Low Income Offer

Name	Date of Birth
Email	Alternate Email
Phone	SSN, TIN or Tribal Id # (last 4 digits)

Service Address

Street	City
State/Province	Zip/Postal Code
Country

Eligibility :

A recipient of an affordability benefit from a utilityEligible for or enrolled in a disability rent increase exemptionEligible for or enrolled in senior citizen rent increase exemptionFree or reduced-price lunch through the National School Lunch ProgramMedicaidU.S. Supplemental Nutrition Assistance Program (SNAP)

Please provide proof of participation by uploading a copy of the benefit statement, notice, letter or other official participation document. The document must include the name of the person participating in the qualifying program, address (must match address where frontier service is requested) and program effective date.

Examples include:

New York State-issued Medicaid card front & back
1095-B Health Care Coverage Form issued within the last 12 months
A current (within 90 days) utility statement displaying an “Energy Affordability Credit with Tier Level”
An in-year award letter stating successful enrollment in either SNAP [Supplemental Nutrition Assistance Program], DRIE [Disability-rent increase exemption] or NSLP [National School Lunch Program]

Click to upload proof of participation document.

Upload another document if needed.

Check this section if the proof of documents are not in the applicant's name.

I certify the person named below:

Is a member of my household ANDIs not already receiving a discounted low-income broadband internet access service from Frontier.

Name on proof documents

Date of birth of person named on proof documents

Last 4 digits of Social Security Number, TIN or Tribal ID Number for person named on proof document

Confirm all required information has been filled in completely and a copy of supporting documents for the program you checked in Step 2 is included prior to submitting the application. You must provide proof of your program participation by uploading a copy of benefit statement, notice letter of participation in a qualifying program, program participation documents, or other official participation document for the program you checked in step 2.

If your program proof is not in your name, you MUST complete the special certification box located directly below the file upload section. Be sure to check both boxes beneath the words "I certify the person named above..." and then fill in the name, date of birth, and last four digits of the Social Security number (or tribal ID number) for the person whose name is on the proof document.

By submitting this form, I certify under penalty of perjury:

The information contained in the application and accompanied documents are true and correct to the best of my knowledge.
The low-income Frontier broadband Internet access service for which I am applying will be billed in my name.
The address listed is my primary residence and not a secondary home or business.
I acknowledge that my household can only receive one low-income broadband internet access service in total, even if my household has more than one internet account.
I authorize Frontier Communications to confirm my continued eligibility for the low-income program.
I am aware that Frontier requires an approval (or recertification) process every two years to ensure continued eligibility for this program, and I may be discontinued from the program if I fail to recertify.
I authorize state and/or federal agencies to discuss with and/or provide Frontier information verifying my participation in benefit programs that qualify me for this program.
I agree to notify Frontier when I no longer participate in any of the qualifying public assistance programs.
I have provided documentation of proof of eligibility along with this application.
By submitting this form, I acknowledge that providing fundamental documentation to receive assistance is punishable by law.

Contact Information