English Español English Free Lifeline Smartphone Referral Program Question Title * 1. Contact Information: First Name Last Name DOB Phone Email Address Address City Zip code Last 4 digits of SSN Question Title * 2. Are you a recipient of any of the following programs? Select all that apply. Medicaid SNAP (Supplemental Nutrition Assistance Program) SSI (Supplemental Security Income) Section 8 Housing Veterans Pension and Survivors Benefit Program Income Base (135% of Federal Poverty Guidelines) Question Title * 3. To verify your identity, please submit government-issued Photo identification. Alternatively, you can send your ID to sbraxton@howardcountymd.gov or text: 240-743-9643. PDF, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Alternatively, you can send your ID to sbraxton@howardcountymd.gov or text: 240-743-9643. Question Title * 4. Notes: Done