iCanConnect/GA Program

National Deaf-Blind Equipment Distribution Program

NDBEDP is the Georgia National Deaf-Blind Equipment Distribution Program that provides communications technology free of charge to low-income people of all ages who have combined vision and hearing loss. The FCC has set aside funding to support one program in each state, plus the District of Columbia, Puerto Rico and the U.S. Virgin Islands. These participating programs will distribute this communications equipment to qualified individuals and provide equipment installation, training and support to help recipients make the most of this technology.

Mission

I Can Connect/GA

The goal of the National Deaf-Blind Equipment Distribution Program (NDBEDP) is to ensure that every person with combined hearing and vision loss has access to modern telecommunication tools and the training necessary to use them, granting every individual the opportunity to interact with the world as an involved, contributing member of society.

FCC Mission

FCC

The National Deaf-Blind Equipment Distribution Program (NDBEDP) enables low- income individuals who are deaf-blind to access 21st Century communications services.  This program will help ensure that qualified individuals have access to the Internet, and advanced communications, including interexchange services and advanced telecommunications and information services.

GCDHH iCanConnect/GA Application Form
To open and print the documents below, you must have Adobe® Acrobat® Reader® installed on your computer. If you do not have this program, you can visit www.adobe.com to download a free copy.

Download iCanConnect/GA Application iCanConnect/GA Application (Updated – 5/14/13)

If you would like an application mailed or faxed please call 1.877.659.4574.

For more information about NDBEDP, please visit iCanConnect.org

ELIGIBILITY REQUIREMENTS:

The following four requirements must be met in order to be eligible to receive free specialized telecommunication equipment.

  • APPLICATION/CERTIFICATE OF NEED
    Applicants must have the application and certificate of need form signed by but not limited to a qualified audiologist, ophthalmologist, medical doctor, hearing/vision aid specialist, hearing aid specialist, vocational rehabilitation counselor, or state certified teacher for the hearing and/or visually impaired that states the nature of their impairment.
  • PROOF OF INCOME
    Applicants must show proof that their annual income does not exceed 400% of the federal poverty level. Sources of proof will include, but may not be limited to, any governmental benefit check stub or letter, pay stub, or W-2 form. If married please provide your spouse’s income.
  • PROOF OF RESIDENTIAL PHONE SERVICE
    Applicants must show proof that they have residential phone or internet service. The applicant’s most recent phone bill will be sufficient documentation.
  • PROOF OF GEORGIA RESIDENCY
    Applicants must be a resident of Georgia. Applicant’s driver’s license, rental agreement, any utility bill or a piece of mail from a government entity.
  • PROOF OF ACCESS TO THESE SERVICES
    If applicant does not have residential phone or internet service he/she must provide proof of access to these services. Proof of access can be via a friend, family member, or public entity.

WHAT IS ICANCONNECT/GA?

iCanConnect/GA is the Georgia National Deaf-Blind Equipment Distribution Program that provides communications technology free of charge to low-income individuals of all ages who have combined vision and hearing loss. The FCC has set aside funding to support one program in each state, plus the District of Columbia, Puerto Rico and the U.S. Virgin Islands. These participating programs will distribute this communications equipment to qualified individuals and provide equipment installation, training and support to help recipients make the most of this technology.

ICANCONNECT/GA Application

ICANCONNECT/GA APPLICATION

( * = required)

APPLICANT

HomeCellVP
SingleMarriedWidowed
(5-17)(18-54)(55 and Up)

PROFESSIONAL INFORMATION

RELEASE OF INFORMATION

I here by request and authorize the following contact to provide/obtain information on my behalf to/from iCanConnect/GA.

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Proof of Disability (Applicants must have the certificate of need form signed by but not limited to a qualified audiologist, ophthalmologist, medical doctor, hearing and/or vision aid specialist, vocational rehabilitation counselor, or state certified teacher for the hearing and/or visually impaired that states the nature of their impairment. Please provide copies of audio gram and latest eye exam with visual acuity levels.):


Proof of Income (benefit letter from Social Security, Bank statement, 2 check stubs, or Tax return – if married please provide your spouse’s current income in addition to your own):


Proof of Residential Phone Service (current legible copy of home phone bill with your name and address on it):


Proof of Georgia Residency (driver’s license or photo ID):


Proof of access to these service (If applicant does not have residential phone or internet service he/she must provide proof of access to these services. Proof of access can be via a friend, family member, or public entity):


All information I hereby authorize to be provided/obtained to/by the above will be held strictly confidential.

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