The Visiting Questionnaire form, identified as CDC 106 and revised in January 2003, is an official document utilized by the California Department of Corrections. Its purpose is to collect relevant information to determine the eligibility of individuals wishing to visit inmates within the institution. It is essential that applicants fill out the form accurately and mail it directly to the visiting office at the inmate's facility, as any incorrect or missing information may lead to the denial of visiting privileges. Individuals interested in applying for visitation rights are encouraged to carefully complete and submit their applications by clicking the button below.
The Visiting Questionnaire form, designed by the STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS, serves as a critical tool in determining an individual's eligibility to visit inmates within its facilities. Thorough in its scope, the form requires applicants to provide detailed personal information, from basic identification data, including names and addresses, to more sensitive details such as criminal history, parole status, and any relations to other inmates. Importantly, the form also accommodates minors wishing to visit, outlining specific requirements for them, such as the necessity for notarized parental consent. Attention to individuals with disabilities is evidenced by provisions ensuring their access needs are met, showcasing the department's commitment to inclusivity. Furthermore, the questionnaire touches on legal aspects relevant to prison visitation, highlighting the potential consequences of policy violations, like the introduction of contraband or attempts to assist inmate escapes – all underscored by the broader aim of maintaining security and order within correctional facilities. This form not only facilitates the vetting process for potential visitors but also underscores the legal and safety frameworks governing inmate visitation rights and restrictions. Compliance with both state laws and institutional regulations is emphasized through the detailed directives given, ensuring that visitors are well-informed of their obligations and the importance of transparency in their submissions. The final decision on visitation rights, communicated by the institution, hinges on the accuracy and completeness of the information provided through this comprehensive questionnaire.
STATE OF CALIFORNIA
DEPARTMENT OF CORRECTIONS
VISITING QUESTIONNAIRE
CDC 106 (Rev. 01/03)
READ CAREFULLY. Please PRINT or TYPE. The information requested will be used by officials of the California Department of Corrections (CDC) to determine whether your questionnaire will be approved or disapproved. The information provided will be maintained in a file pertaining to the inmate.
In accordance with the Privacy Act of 1974 (PL93-579), providing your Social Security number is optional. However, any omission or falsification on this questionnaire may be cause for denial of visiting. Please mail this form directly to the visiting office of the institution where the inmate is confined.
1. NAME OF INMATE YOU WANT TO VISIT (LASTFIRSTMIDDLE)INMATE’S CDC NUMBER
2. YOUR NAME (Print your name exactly as indicated on the photo identification you will he using)
SUFFIX (Jr., Sr., etc.)
HOME TELEPHONE NUMBER
( )
3. MAIDEN NAME (If applicable)
HAVE YOU EVER USED ANOTHER NAME? IF SO, PLEASE LIST
RELATIONSHIP TO INMATE: (Spouse, Son/Daughter, other)
4. DATE OF BIRTH (Mo/Day/Yr)
GENDER (Check one)
BIRTHPLACE (City
County
State
Country)
MALE FEMALE
5. ID NUMBER
ID TYPE (Check one) q DR1VER’S LICENSE
STATE ID
MILITARY ID
USINS CARD
MCAS
PASSPORT
OFFICIAL USE ONLY
ISSUED BY (County
Slate
6. SOCIAL SECURITY NUMBER
EXPIRATION DATE.
7. CURRENT RESIDENCE ADDRESS: STREET ADDRESS Apt. ft (If Aplicable)
CITY
STATE
ZIP CODE
8. MAILING ADDRESS: (If different from Residence Address)
9. PREVIOUS ADDRESS WITHIN PAST TWO YEARS: Apt. ft (If Applicable)
10. ACCOMPANYING MINOR(S) (If Any): NAME, DOB, RELATIONSHIP TO INMATE
1. 2.
3.
10. Continued
4.
5.
6.
11. HAVE YOU EVER VISITED ANOTHER INMATE(S) IN A CALIFORNIA PRISON?
(Check one) YES
O NO
If YES, complete Item 11 A. Attach additional sheet(s) if more than two inmates.
11 A. INMATE NAME
CDC NUMBER
INSTITUTION WHERE YOU VISIT INMATE
RELATIONSHIP TO INMATE
I.
2.
12. HAVE YOU EVER BEEN DETAINED, ARRESTEQ,©XCONVICTED OF A CRIME? If YES, complete Item 12A. List all detentions, arrest and/or convictions. Failure to list all requested
(Check one) Q YES
NO
information may .result jn-denial of visiting. Attach additional sheet(s) if necessary.
12A. OFFENSE
APPROX. DATE
DISPOSITION: (Dismissed, Probation, Jail, Prison)
COUNTY
13. ARE YOU ON PROBATION?
ARE YOU ON PAROLE OR CIVIL
HAVE YOU BEEN INCARCERATED IN A STATE
14. ARE YOU CURRENTLY UNDER ANY TYPE OF COURT
(Check one) QygS
ADDICT OUTPATIENT STATUS?
ADULT/JUVENILE CORRECTIONAL FACILITY?
IMPOSED PROGRAM? (Check one) Q YES
(Check one)
Q YES
if YES, please explain on additional sheet and attach to this form.
If YES, answer 13 A.
If YES, answer 13A.
If YES, read 13B
13A. TYPE: (Court, Formal,
SUPERVISING AGENCY
NAME, ADDRESS, AND TELEPHONE NUMBER OF YOUR PROBATION/PAROLE
Informal, etc.)
OFFICER:
13B. If you were discharged from an institution or discharged from parole or outpatient status within the last twelve (12) months, you must have prior written approval of the Warden before visiting will be permitted. You will also need to provide a copy of your discharge paperwork.
CONrCWlED ON BACK PAGE
15.If you are under 18 years of age and are not an emancipated minor or the inmate’s legal spouse, you must have the written notarized consent of a parent or legal guardian and be accompanied by a responsible adult who is also approved to visit. The notarized written consent must be presented each time a minor visits unless prior approval has been attained form the Warden for an inmate to visit with his or her unchaperoned children.
16.VISITORS WITH DISABILITIES: If you have special requirements related to your disability (medical implants, prosthetic devices or requiring
mobility assistive devices, i.e.,. crutches, walkers, braces, wheelchairs, battery operated or custom prescribed wheelchairs, guide dog for the visually or hearing impaired, insulin kit with syringes, etc.) you will need to attach a verifying statement from your physician. Visitors with guide dogs will need to provide the dog’s certification paperwork upon visit check-in. The CDC will make every effort to provide reasonable accommodations for all qualified/eligible visitors with disabilities in keeping with the safety and security of the institution and the public. If you have any questions and/or concerns, please contact the institution where the inmate is confined.
17.The following laws relate to prison visitation:
SUBJECT TO SEARCH: Visitors entering the correctional institution, camp or facility grounds are subject to a search of their person, vehicle and property. Except as described below, visitors may leave the institution, camp, or facility grounds rather than submit to a search of their person, vehicle or property. Refusal to submit to the search will result in denial of visiting for that day.
Visitors may not elect to leave the correctional institution, camp or facility grounds rather than submit to a search when institution officials possess a court issued search warrant or cause for a search arises while the visitor is on the institution grounds and the cause for the search is believed by institutional officials to be a criminal offense.
FIREARMS AND DRUGS ON INSTITUTIONAL GROUNDS /ASSISTING INMATES TO ESCAPE: It is a felony for anyone to assist inmates to escape. Bringing firearms, deadly weapons, explosives, tear gas, drugs, drug paraphernalia, or selling drugs on prison grounds, or giving/selling inmates firearms, weapons, explosives, liquor, cocaine, or other narcotics or any kind of drugs, including marijuana, is a crime (Sections 2772, 2790,4534, 4535, 4550, 4573, 4573.5, 4573.6, 4573.8, 4573.9, 4574, 4600, California Penal Code).
GIVING LETTERS TO INMATES OR TAKING LETTERS OUT FOR INMATES BY ANYONE IS A MISDEMEANOR: (Section 4570, 4570.1, California Penal Code).
FALSE IDENTIFICATION: Anyone who falsely identifies himself/herself to gain admittance to a prison is guilty of a misdemeanor. Persons previously convicted of a felony in the State who come upon the grounds of a prison without permission of the official in charge are guilty of a felony (Section 4570.5, 4571 California Penal Code).
TRESPASSING: Entry on institution property for unauthorized purposes will be considered trespassing as provided in Section 602(j) of the California Penal Code. Refusal or failure to leave the property when requested to do so by an official will be considered trespassing as provided in Section 602(p) of the California Penal Code.
PERIOD OF EMERGENCY: In the event of an emergency situation that affects a significant portion of the inmate population at an institution, the visiting program and other program activities may be suspended during the period of emergency (Section 2601(d), California Penal Code).
GIVING OR RECEIVING GIFTS: Giving or receiving gifts to or from inmates is a misdemeanor (Section 2540, 2541, California Penal Code).
HOSTAGES: Hostages will not be recognized for bargaining purposes during attempted escapes by inmates (Section 3304, California Code of Regulations, Title 15, Division 3, Chaper 1).
18. If you are APPROVED to visit, the inmate will be notified and it is his/her responsibility to notify you.
If you are DISAPPROVED to visit, the institution will notify you by mail. You will not be allowed to visit until your application is approved.
I have read and understand the above information and agree to follow all
Federal, State and CDC rules and regulations.
VERIFICATION OF MAILING
I have mailed this Visiting Questionnaire to the visitor applicant.
VISITOR SIGNATURE
DATE
inmate;/£i6nature / cdc #
date
|
OFFICIAL USE ONLY-TO BE COMPLETED BY INSTITUTION STAFF
APPROVED
----------------------------------------------------------------------------------Criminal History:
O NO O YES CII/FBI #
—
.
DISAPPROVED, for the following reason(s):
(If DISAPPROVED, the applicant and inmate are to be informed in writing of the disapproval.)
Omissions and/or falsifications Section(s):
Need copy of Declaration of Discharge
Need
disposition(s)
for:
Applicant is under:
parole
formal probation
Civil Addict Outpatient supervision
Arrest record received via DOJ indicates applicant has an extensive and /or recent history of criminal activity for offenses that are particulary sensitive to the institutional security. May reapply after: (DATE:)
Applicant’s privileges to visit will be reconsidered:
upon receipt of the above requested information
and/or
after (DATE:
)
PRINT NAME
SIGNATURE
TITLE
INSTITUTION
INMATE/V1S1TOR NOTIFIED ON (DATE)
BY WHOM
Filling out the Visiting Questionnaire form is an important step for those wishing to visit an inmate in a California correctional institution. This detailed form seeks to gather essential information that the Department of Corrections will use to evaluate and determine if a visit can be granted. Careful completion of this form is crucial to ensure that all provided information is accurate and comprehensive to avoid any possible delays or denials in the visiting approval process. Here’s a step-by-step guide to help you fill out the form correctly.
After submission, the correctional institution will process your application. Approval or denial of your visiting request will be communicated accordingly. If approved, the inmate you wish to visit will be notified, who in turn should inform you. Conversely, if your application is not approved, the institution will notify you by mail. The successful completion of this form is pivotal for those aiming to visit inmates, requiring attention to detail to ensure the visiting process proceeds smoothly.
The Visiting Questionnaire form serves as a tool for officials at the California Department of Corrections (CDC) to assess whether an individual seeking to visit an inmate is eligible for approval. The information provided helps maintain security and safety within the institution and ensures that all visits comply with federal and state regulations.
In accordance with the Privacy Act of 1974, providing your Social Security number on the form is optional. However, failure to provide accurate information, including your Social Security number if you choose to do so, may result in the denial of your visiting privileges due to incomplete information for the assessment process.
The completed Visiting Questionnaire form should be mailed directly to the visiting office at the institution where the inmate is confined. This ensures that the form is processed by the appropriate officials and helps expedite the review of your request to visit.
If you have been detained, arrested, or convicted of a crime, you must disclose all such instances on the form. Failure to list all requested information might result in the denial of visiting privileges. Attach additional sheets if necessary to provide comprehensive details about each incident, including the nature of the offense, approximate date, and disposition.
Minors under 18 years of age who are not emancipated or the inmate’s legal spouse must have the written notarized consent of a parent or legal guardian to visit an inmate. They must also be accompanied by a responsible adult who is approved to visit. The notarized consent must be presented each time a minor visits, unless prior approval has been obtained from the Warden.
Visitors with disabilities who require special accommodations (medical implants, prosthetic devices, mobility assistive devices, etc.) need to attach a verifying statement from their physician to the questionnaire. The CDC strives to provide reasonable accommodations for all qualified visitors with disabilities, consistent with the safety and security of the institution and the public.
If your application to visit is disapproved, the institution will notify you by mail outlining the reason(s) for the disapproval. You will not be allowed to visit until your application has been approved. Depending on the reason for disapproval, you may need to provide additional information or wait until a specified date to reapply for visiting privileges.
Filling out the Visiting Questionnaire form for the California Department of Corrections requires attention to detail and honesty. However, people often make mistakes that can result in delays or denial of their request to visit. Here are eight common errors:
Common pitfalls also include overlooking the instructions about searches, firearms, drugs, and gifts which are clearly explained in the guidelines. Being mindful of these can prevent any misunderstandings during your visit.
By avoiding these common errors, visitors can ensure their paperwork is in order and increase their odds of approval.
When individuals wish to visit inmates in the California Department of Corrections, the Visiting Questionnaire form is a primary document required to initiate the process. However, to ensure a comprehensive understanding and adherence to the regulations set by the Corrections Department, several other forms and documents often accompany this questionnaire. These forms are essential for a smooth visitation process, ensuring both the visitor's and the inmate's safety, as well as aligning with legal requirements.
In addition to the Visiting Questionnaire, these documents play a critical role in the thorough and secure process of inmate visitation. Each form addresses different aspects of the visitation rights, responsibilities, and security protocols, thereby contributing to a structured and safe environment for both visitors and inmates. It is imperative that all prospective visitors familiarize themselves with these requirements and prepare accordingly to facilitate a smooth and compliant visitation experience.
The Employment Application Form is quite similar to the Visiting Questionnaire in that it also collects personal information, including past addresses and employment history, to evaluate the suitability of the applicant. Just as the questionnaire aims to assess the risk and appropriateness of a potential visitor, the Employment Application serves an analogous purpose in the employment context.
Tenant Application Form closely mirrors the Visiting Questionnaire by requiring applicants to provide current and previous addresses, financial information, and sometimes references. This parallels the questionnaire’s requirement for detailed personal information to assess eligibility and security risks.
The Visa Application Form shares similarities with the Visiting Questionnaire in its requirement for detailed personal information, travel history, and intentions for the visit. Both forms scrutinize the applicant's background to ensure compliance with legal and institutional regulations.
A Loan Application Form is also akin to the Visiting Questionnaire. It gathers detailed personal and financial information to assess the applicant's risk and eligibility. Both forms are integral in a decision-making process that grants or denies a request based on provided information.
The Volunteer Application Form resembles the Visiting Questionnaire in how it collects personal details, past volunteer or work experience, and references to evaluate the suitability of the applicant for a role. This is similar to how the questionnaire adjudicates the appropriateness of a person’s visitation rights.
Medical History Form parallels the Visiting Questionnaire through its collection of personal and sensitive information for evaluation purposes. Though the contexts differ, both serve to determine the appropriateness and risks of allowing an individual into a specific environment.
The Adoption Application Form is similar in its comprehensive gathering of personal, financial, and background information to assess the suitability of applicants. Like the Visiting Questionnaire, it aims to protect the welfare of those it is designed to serve by ensuring that applicants meet certain criteria.
School Registration Form also bears resemblance to the Visiting Questionnaire by requiring detailed personal information, educational background, and sometimes health information, to decide on the eligibility of the applicant for admission, analogous to how visitor eligibility is determined.
A Background Check Authorization Form is comparable because it collects personal information and consents to investigate one’s background, similar to how the Visiting Questionnaire screens for potential security risks among visitors.
When filling out the Visiting Questionnaire form for visits within the California Department of Corrections, attention to detail and honesty play a crucial role in the approval process. Here are eight dos and don'ts to guide you:
By following these guidelines, you’ll enhance the likelihood of your visiting questionnaire being approved, facilitating a smoother path to maintaining connections with incarcerated loved ones.
When it comes to the Visiting Questionnaire form required by the California Department of Corrections, there are numerous misconceptions that can often lead to confusion and even anxiety among those looking to visit inmates. Understanding these misconceptions can help clarify the process, making it easier and more straightforward for potential visitors.
Misconception 1: Social Security numbers are mandatory. While the form asks for your Social Security number, it clearly states that providing this piece of information is optional, in line with the Privacy Act of 1974.
Misconception 2: Any omission or mistake will permanently ban you from visiting. While it's true that omissions or falsifications may cause denial, this does not necessarily mean a permanent ban. Applicants often have the option to clarify or correct information and reapply.
Misconception 3: If you’ve been convicted of any crime, you’ll automatically be disapproved. The form requires disclosure of detentions, arrests, or convictions, but this doesn't automatically disqualify an applicant. Each case is considered individually.
Misconception 4: Only immediate family members can submit a Visiting Questionnaire. The form is open to various relations, not exclusively to immediate family members, allowing friends and other relations to potentially visit, depending on the approval process.
Misconception 5: Approval is at the discretion of the inmate. While the inmate will be notified if you are approved, the actual approval comes from the institution staff, not the inmate themselves.
Misconception 6: The form’s approval means you can visit anytime. Approval to visit is just the first step; visits must be scheduled according to the institution's rules and the inmate's privileges.
Misconception 7: Minors need approval only once to visit. If a minor is not an emancipated minor or the inmate’s legal spouse, they require notarized consent for each visit unless prior approval has been granted by the Warden for unchaperoned visits.
Misconception 8: You can bring gifts or money for the inmate. The form clearly stipulates that giving or receiving gifts or money to/from inmates is prohibited and considered a misdemeanor.
Misconception 9: Visitors with disabilities cannot be accommodated. The CDC makes efforts to accommodate visitors with disabilities, including making special arrangements for those requiring assistance or devices for mobility, as long as these needs are communicated in advance.
Misconception 10: The visiting questionnaire covers all the necessary information for visiting. While it is a crucial part of the process, visitors also need to be aware of the rules concerning searches, prohibited items, and other visitation guidelines that are highlighted in the form.
It’s important for potential visitors to read the questionnaire carefully and understand the requirements and guidelines provided by the California Department of Corrections to ensure a smooth and trouble-free visitation process.
When you're planning to visit someone in a California state prison, you need to fill out a Visiting Questionnaire form correctly. Here are 10 key takeaways that can help ensure your visit goes smoothly:
Remember, the inmate will be informed if you are approved to visit, and it's their responsibility to notify you. If your application is denied, you will receive a notice by mail. This procedure ensures both the visitor's and the inmate's safety, aligning with the institution's security protocols.
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