Emergency Broadband Benefit Program Emergency Broadband Benefit Program Consent Form Name* First Last Phone*Your current phone number with McDonald County TelephoneDate MM slash DD slash YYYY Email* Yes! Enroll me in the EBB program.* I affirm to enrolling in the Emergency Broadband Benefit Program and have read the disclosure belowThe Emergency Broadband Benefit (“EBB”) is an FCC program to help eligible households pay for internet service during the Covid-19 pandemic. The EBB Program will provide a discount of up to $50 per month (up to $75 per month for households on Tribal lands) toward broadband internet service for eligible households. A household is eligible for the EBB if: (1) it qualifies for the FCC Lifeline program; (2) it receives benefits under the free and reduced-price school lunch program or the school breakfast program, including through the USDA Community Eligibility Provision, or did so in the 2019-2020 school year; (3) it received a Federal Pell Grant during the current award year; or (4) it experienced a substantial loss of income since February 29, 2020 and the household had a total income in 2020 below $99,000 for single filers and $198,000 for joint filers. The EBB Program will conclude when the fund is expended or six months after the Emergency Period as defined in the Consolidated Appropriations Act, whichever is sooner. You may obtain EBB-supported broadband service from any participating provider of your choice and you may transfer your EBB benefit to another provider at any time. You remain responsible for monthly payment to McDonald County Internet Company. After EBB, McDonald County Internet Company's regular rates apply. McDonald County Internet service is subject to the Terms of Service agreement found at https://olemac.net/tos . All application and eligibility decisions are made by the FCC. For more details visit: https://www.fcc.gov/broadbandbenefitMy Responsibilities* I understand that, at the termination of the EBB program or if eligibility requirements change, I would be responsible to either discontinue services or pay the amount that was previously paid by the EBB program. It is NOT the responsibility of McDonald County Telephone or Internet to contact me of any changes to the EBB program.Consent* I agree for McDonald County Internet Company to transmit my subscriber information to the National Lifeline Accountability Database.Verification - Initials* Please enter your initials (First, Middle, Last) to verify that the information on this consent form is correct.