Residents of licensed nursing homes, intermediate care facilities and assisted living facilities are eligible to request coupons from the TV Converter Box Coupon Program.  Residents must use the Nursing Home application form.

If you are a resident of a licensed nursing home, intermediate care facility or assisted living facility, you may apply for one coupon by mailing in the completed application displayed on this page. A family member or a representative from the licensed facility may apply for one coupon per nursing home resident, but the coupon will be mailed directly to the nursing home resident.

To address the possibility of waste, fraud and abuse, the Coupon Program will be vigilant and will deny applications that appear to be fraudulent. The address of each applicant will be checked against a third-party database to assist in validating eligibility.

Consumers who apply for coupons are approved on a first-come, first-served basis, while supplies last. If the Program experiences high demand, it may be necessary for the Coupon Program to place applicants on a waiting list. Should this happen, we may distribute coupons to over-the-air only households first to ensure that as many US households as possible have at least one working television after their local TV stations complete the transition to digital by June 12, 2009.

If you have additional questions, please visit our FAQs for more information.