• TAI Application for Equipment

  • Please fill out all questions completely.

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  • Do You Qualify?

    If you do not answer "Yes" to any of the qualifying questions below, then you may be ineligible for our program. If you have any questions or concerns about these qualifying questions, please contact us at 800-606-5099.
  • If you clicked no and do not live in Iowa, then you may not be qualified for the program. If you have any questions or concerns about this qualifying question, please contact us at 800-606-5099.

  • If you clicked no, then you may not be qualified for the program. If the applicant is under five years old, please contact us at 800-606-5099.

  • To rephrase the question: Do you have a landline hooked up in your house? If you still clicked no, then you may not be qualified for the program. If you have any questions or concerns about this qualifying question, please contact us at 800-606-5099.

  • If you clicked no, then you may not be qualified for the program. If you have any questions or concerns about this qualifying question, please contact us at 800-606-5099.

  • If you clicked no, then you may not be qualified for the program. If you have any questions or concerns about this qualifying question, please contact us at 800-606-5099.

  • Annual Total Family Income

    • 1 person - $66,000
    • 2 persons - $76,000
    • 3 persons - $86,000
    • 4 persons - $96,000

    (add $9,000 for each additional person)

  • Equipment Needed

    You can choose one category to select an equipment (telephone), but applicants may also select a separate Phone Ringer/Signaler and/or an Amplified Answering Machine, if desired. Scroll down to see options.
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  • If you need specialized telephone equipment or an accessory that is not on the list, or need assistance with the form, please contact the TAI office at 800-606-5099.

  • Professional Signature Required

    If you have not applied to TAI, then you will need a professional signature to verify your hearing loss or your speech difficulty. Please enter your professional's information below, and follow the instructions on the next page on how to get verified.

    You must receive a signature by your doctor, audiologist, voc rehab counselor, state or federal agency representative, or any other licensed professional in the field of hearing or speech.

    The professional should be YOUR "personal" professional, such as your family doctor, a regular audiologist, a sign langauge interpreter you know. Someone that you have an established relationship with. 

    Their signature verifies you have a need for specialized telecommunications  equipment to assist communication over the telephone.

  • It is recommended that after you submit this application you reach out to your professional to let them know they will be receiving an email from Telecommunications Access Iowa requiring their verification and signature.

  • Your Signature Required

    By my signature below, I certify that all of the above information is true. By signing this application form, I agree to participate in any follow up survey in order to assure quality customer service and satisfactory use of my equipment. I understand that I am only allowed to receive one item or package of items per family household every five years. I become the owner of the items I receive and am responsible for the maintenance and warranty. I must use the voucher at an authorized equipment vendor by the deadline listed on the form. I agree to pay any remaining cost that is not covered by the Telecommunications Access Iowa Voucher Program.

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