Section 757.EXHIBIT D Lifeline Verification Ineligibility Notice

NOTICE OF REMOVAL FROM THE LIFELINE WAIVER PROGRAM

LEC (UTILITY) NAME

LEC PHONE #

Customer Name

Address

City, State, Zip

Phone Number

Account Number



Records show that you are not receiving benefits under one of the following programs:

		Food Stamps
		Medicaid
		Supplemental Security Income
		Federal Public Housing Assistance
		Low-Income Home Emergency Assistance Program
		National School Lunch Free Lunch Program
		Temporary Assistance to Needy Families

You will therefore be removed from the Lifeline Program.

TO AVOID REMOVAL IF YOU ARE STILL RECEIVING BENEFITS

1.	If you are still receiving benefits under one of the above listed programs, call the applicable agency.

2.	If the agency has your name on their master list, then call your LEC.

IF YOU NEED TO REAPPLY

1. If you reapply for benefits under one of the programs listed above and the agency grants your application before (Date) ______, call your LEC to have your eligibility checked.

2. If your application is granted by the agency after (Date) _______, you can reapply for the Lifeline benefits by calling your LEC.

3. There will be no retroactive Lifeline benefits between the time that your benefits are discontinued and the time that your application is approved.

REMOVAL IN ERROR

If you believe that the agency has improperly terminated you from one of the listed programs, you must resolve this with the applicable agency.

If your benefits are continued while the dispute is pending, your Lifeline benefits will also be continued.

If your benefits are not continued while the dispute with the applicable agency is pending, you will not receive Lifeline benefits until you have won your appeal.

Call your LEC to let them know if your benefits are being continued and/or if you have won your appeal.

There will be no retroactive Lifeline benefits between the time that your benefits are discontinued and the time that your application is approved.

(Source: Amended at 32 Ill. Reg. 8583, effective June 1, 2008)