Lifeline Pass Online Application

New Applicants

Please select "New Lifeline Card" below and complete the application. Your Lifeline ID card will be mailed to you.

Replacement Cards

Please select "Replacement Lifeline Card" and complete the application. Your replacement Lifeline ID card will be mailed to you.

What are you applying for?

New Lifeline Card

Replacement Lifeline Card

Contact Information

First Name

Last Name

Date of Birth

If you are 5-18, 65+ years of age, or have a disability, please apply for the Free Muni Program instead of Lifeline.

Phone Number

Mailing address (including unit #)

City

State

Zip Code

Proof of Income

Upload one of the following proofs of income here.

Medi-Cal card
SNAP or EBT card
Women, Infants & Children (WIC) Supplemental Nutrition Program (screenshot of your phone app)
San Francisco Department of Homelessness and Supportive Housing (HSH) Coordinated Entry eligibility letter
Unemployment Benefits letter from EDD letter stating you have applied for or are receiving benefits. Letter must be issued in 2020. Acceptable forms include:
- Application receipt notice - example
- Benefits receipt notice - example
- New account confirmation email from EDD

I can provide one of the above proofs of income:

YesNo, I cannot provide proof of income

Proof of Income:

*Uploaded file must be less than 20 MB. File types are restricted to Microsoft Office file type, jpg, png, and pdf.

Check this box if you do not have one of the above items, but still qualify based on income. If requested, you will be required to provide documentation proving income level. Failure to respond will result in termination from the program and/or administrative fines.

I Agree

Household Size / Annual Income

1- $25,520
2 - $34,480
3 - $43,440
4 - $52,400
5 - $61,360
6 - $70,320

Requirements

By submitting this form you (1) attest the information provided is true and accurate and (2) understand the SFMTA may conduct audits, and (3) if requested, you will be required to provide documentation proving income level.

Failure to respond will result in termination from the program and/or administrative fines.

I Agree to the requirements above

Yes