Transfer Exception Worksheet

Use this worksheet if you need to transfer your Affordable Connectivity Program (ACP) benefit, but have been told that you need an exemption to make an additional transfer in this calendar month.

Please check the appropriate statement if one of the exceptions below applies to your household:

You believe that an internet company transferred your ACP benefit without providing you with the required disclosures and/or obtaining your consent to transfer your ACP benefit;

Your household’s internet company stopped operating or failed to provide internet service; or

You moved to a location outside of your current internet company’s service area.

By signing, you agree that the information you provided on this form is true and correct to the best of your knowledge.

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Enter your full legal name

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