Nebraska Telephone Assistance Program (NTAP) Application and Certification Form

The Nebraska Telephone Assistance Program (NTAP) is administered by the Nebraska Public Service Commission. NTAP reduces the cost of local phone service by $12.75 per month. Not all phone companies offer NTAP in all coverage areas. Please note: If you are completing this application for someone other than yourself, you will need to provide NTAP with a complete copy of your Durable Power of Attorney or Guardianship documents. You may also be required to provide documentation showing your current participation in an eligible program, or that your household income is at or below 135% of the poverty level.

(If you live on Tribal land, DO NOT use this application. Contact your local phone company for a Tribal land discount.)

APPLICANT INSTRUCTIONS: In order to be approved to receive assistance on your phone bill you must complete and sign this application. Read this application completely, answer all questions on this form, provide all documents requested, sign this application and press submit.

Have Questions? Call 1-800-526-0017 or in Lincoln, 402-471-3101

Applicant's Complete Social Security Number: --

United States Citizenship Attestation: For the purpose of complying with Neb. Rev. Stat. ยงยง 4-108 through 4-114, I attest as follows:


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Applicant Name: First Middle Last

Applicant's Date of Birth: //

There are members in my household including applicant.