BIENNIAL AUDIT PLAN, UNIVERSAL SERVICE FUND – LIFELINE PROGRAM, APPENDIX A, TABLE 1
Study Area 
Code Last Name First Name
Physical/
Service 
Address
Apt, Unit, or 
Lot # City State Zip
Telephone 
Number Date of Birth
Last Four 
SSN Digits or 
Tribal ID No.
Service Start 
Date
Lifeline Start 
Date
Lifeline 
Disconnect Date 
(if Applicable)
Non-Tribal 
Lifeline Credit
Tribal Lifeline 
Credit
Tribal Link-Up 
Credit TLS Credit
Page 1 of 1