Benefits in Action — Navigator Portal

Client Entry

Client Info

Review & Submit

ℹ️

How this works: Look up an existing client or start a new one. Upload a completed PEAK form for auto-fill, or enter information manually. Benefits in Action receives the data for your database, and Fair Benefits can submit a Lifeline application on the client's behalf.

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Look Up Existing Client

Search by name, DOB, or phone

or start a new client

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Drag & drop or click to upload PEAK form

Accepts PDF, JPG, or PNG — Colorado PEAK application form only

✅ form_peak_martinez.pdf uploaded — data extracted below

Confirm Client Information

✏️ Review and correct the auto-extracted data below before proceeding. Fields pulled from the PEAK form are pre-filled.

Personal Details

First Name *

Last Name *

Date of Birth *

SSN Last 4 *

Used to verify Lifeline eligibility only — not stored

Contact

Phone Number

Email Address

Optional — for application confirmation

Residence

Street Address *

City *

State

ZIP Code *

Household & Eligibility

Household Size *

Primary Program on PEAK Form *

Free Phone Service (Lifeline)

📱 This client is interested in a free Lifeline phone plan

Check this box to select a provider and submit a Lifeline application alongside the PEAK form.

✓

Submitted Successfully

The PEAK form data has been sent to Benefits in Action's database, and the Lifeline application has been routed to the selected provider.

Client—

Provider—

Submission ID—

Timestamp—

Routed to BIA DB—

Lifeline Application—