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iCanConnect Deaf-Blind Disability Verification

The FCC's National Deaf-Blind Equipment Distribution Program, known as iCanConnect, provides communication technology to people with combined hearing and vision loss through state-certified local programs. Each application needs a professional to attest that the applicant's combined loss meets the program's definition of deaf-blind. There is no single national form: each state program publishes its own application with a disability verification section.

Who completes it

The applicant completes the state program's application and income documentation. A medical or health professional, vision or hearing professional, educator, vocational rehabilitation counselor or community service provider completes the disability verification.

Submitting and payment

How to submit it
Send the application to the applicant's state or territory iCanConnect program; most local applications can be downloaded from that program's contact page on icanconnect.org.

Good to know

  • Vision qualifies at 20/200 or less in the better eye with correction, a visual field of 20 degrees or less, or progressive loss expected to reach either level.
  • Hearing qualifies when chronic loss is so severe that most speech cannot be understood with optimum amplification, or progressive loss is expected to reach that level.
  • Household income must be within 400% of the Federal Poverty Guidelines, or the applicant can show enrollment in a program such as Medicaid, SSI, public housing or Section 8, or SNAP.
  • Professional verification of disability is required by the FCC's NDBEDP rule at 47 CFR 64.6207.

Get the official form

Download the current version from the source each time; forms change without notice.

Deaf-Blind Equipment Program Application (disability verification)

Official page

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who can verify deaf-blindness for iCanConnect?

iCanConnect gives examples including a healthcare provider, vision or hearing professional, educator, vocational rehabilitation counselor or community service provider. The professional attests that the applicant's combined hearing and vision loss meets the program's definition, which sets thresholds for visual acuity, visual field and speech understanding with amplification.

Is there a national iCanConnect application form?

No. Each state or territory's certified program publishes its own application, so the verification section's layout varies. Contact the local program listed on icanconnect.org or download its application there. The iCanConnect site also has a Spanish version.