Lifeline Pass Application
The Lifeline Pass is a Muni-only monthly pass for adults (ages 19-64) on a limited income. The pass is
offered at a 50% discount off the standard adult monthly pass price.
Applicant for low income discounts must be have a household income at or below the following limits:
*Add $8,960 per household member above eight
Customer Information
First Name:
Last Name:
Mailing Address:
Apartment:
City:
State: Zip:
Date of Birth: Phone Number:
If your application is
accepted, your last transit citation issued within 30 days of enrollment is eligible for
dismissal. Please provide a citation or ID number from the citation so that we may review your record.
Citation or ID Number:
- complete the steps below
Replacement Cards – provide customer
information only
Step 1 – Attach a copy of a government issued photo ID
Step 2
□
Option 1 – Attach a copy of one of the following:
▪
Medi-Cal or California Electronic Benefit Transfer (EBT) card
▪
Women, Infants & Children (WIC) Supplemental Nutrition Program
▪
Proof of current application for, or receipt of Unemployment Benefits letter from EDD, including:
• Application receipt notice
• Benefits receipt notice
• New account confirmation email from EDD
□
Option 2 – Complete the authorization form on the following page to allow the SFMTA, or its towing
contractor AutoReturn, to verify receipt of income eligible service from the San Francisco Department of
Human Services.
□
Option 3 - I certify that I meet the annual income requirements above, however, I am not currently
participating in any programs listed. I understand that the SFMTA may request documentation, including
copies of recent tax returns, to verify income at any time and failure to respond will result in termination
from the program and/or the application of administrative penalties. Please sign and date below.
Signature Date
click to sign
signature
click to edit
![]()
