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The Visiting Questionnaire form is an essential tool for anyone wishing to visit an inmate in California’s correctional facilities. It serves to collect critical information about both the visitor and the inmate, ensuring a smooth processing of visiting privileges. When filling out the form, individuals will be required to provide various details, such as the inmate's name, CDC number, and the visitor's personal information, including their home address, contact numbers, and identification details. The form also emphasizes the importance of accuracy; any false information or omissions can lead to the denial of visiting rights. In addition to personal information, visitors must disclose their relationship to the inmate and any previous visiting history. There are also questions regarding the visitor’s criminal background, probation or parole status, and any accompanying minors. Completing the questionnaire correctly and submitting it to the appropriate institution's visiting office is crucial. Furthermore, the form highlights compliance with specific laws and regulations pertaining to prison visits, ensuring the safety and security of both visitors and inmates. Understanding these aspects will better prepare visitors for the process and aid in a successful visiting application.

Visiting Questionnaire Example

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 DR1VERS LICENSE

 

 

STATE ID

MILITARY ID

 

 

 

USINS CARD

 

 

MCAS

PASSPORT

 

OFFICIAL USE ONLY

ISSUED BY (County

 

Slate

 

 

Country)

 

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)

 

 

 

 

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

 

 

9. PREVIOUS ADDRESS WITHIN PAST TWO YEARS: Apt. ft (If Applicable)

 

 

CITY

 

STATE

ZIP CODE

 

 

 

 

 

 

 

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

STATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

NO

ADDICT OUTPATIENT STATUS?

ADULT/JUVENILE CORRECTIONAL FACILITY?

 

IMPOSED PROGRAM? (Check one) Q YES

NO

 

 

 

(Check one) Q YES

NO

(Check one)

Q YES

NO

 

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

COUNTY

STATE

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

DATE

 

 

 

 

 

 

 

INMATE/V1S1TOR NOTIFIED ON (DATE)

BY WHOM

Form Characteristics

Fact Name Description
Purpose of the Form The Visiting Questionnaire (CDC 106) is designed for the California Department of Corrections to evaluate and determine eligibility for visiting inmates.
Privacy Act Compliance Submission of Social Security numbers is voluntary, as stated by the Privacy Act of 1974 (PL93-579), ensuring protection of personal information.
Potential Consequences Providing false information or omissions may lead to the denial of visiting privileges, emphasizing the importance of accuracy.
Mailing Instructions The filled questionnaire must be mailed directly to the visiting office of the institution where the inmate is located.
Approval Notification If the application is approved, the inmate will be informed. Conversely, disapproval notifications will be sent via mail to the applicant.
Legal Framework The visitation process falls under various sections of the California Penal Code, notably sections addressing conduct, trespassing, and false identification.

Guidelines on Utilizing Visiting Questionnaire

Filling out the Visiting Questionnaire form is an important step for anyone wishing to visit an inmate in California's correctional facilities. Completing this form accurately can help ensure that the application process goes smoothly. After you finish filling out the form, mail it directly to the visiting office of the institution where the inmate is located. Below are the steps to properly complete the form.

  1. At the top, fill in the NAME OF INMATE you want to visit, including their last name, first name, middle name, and CDC number.
  2. Next, provide YOUR NAME exactly as it appears on your photo ID, along with any suffix (e.g., Jr., Sr.). Also, include your home telephone number.
  3. If applicable, include your MAIDEN NAME and list any other names you have used.
  4. Fill in your DATE OF BIRTH, select your gender, and enter your birthplace (city, county, state, country).
  5. Choose your ID TYPE from the given options (e.g., driver’s license, passport), and provide the ID number and its expiry date.
  6. Enter your current RESIDENCE ADDRESS, including street address, apartment number if applicable, city, state, and zip code.
  7. If your MAILING ADDRESS is different, fill that in as well.
  8. Provide your PREVIOUS ADDRESS within the last two years, if applicable.
  9. List any ACCOMPANYING MINOR(S) with their names, dates of birth, and relationship to the inmate.
  10. Indicate if you have ever visited another inmate by checking YES or NO. If yes, complete related information.
  11. Answer whether you have been detained, arrested, or convicted of a crime. If yes, provide the details.
  12. Check if you are on probation or parole, and fill out additional required information if you are.
  13. If you are under 18 and not an emancipated minor or legal spouse of the inmate, ensure you have notarized consent from a parent or guardian.
  14. If you have special needs due to a disability, mention them and attach a verifying statement from your physician.
  15. Sign the form indicating that you have read and agree to the rules and regulations.
  16. Mail the completed form to the appropriate visiting office of the correctional institution.

What You Should Know About This Form

What is the purpose of the Visiting Questionnaire form?

The Visiting Questionnaire form is used by the California Department of Corrections (CDC) to evaluate whether an individual is eligible to visit an inmate. Information collected on this form helps officials determine approval or disapproval of visiting requests. It is essential to be truthful when filling out the form, as any inaccuracies or missing information may result in denial of a visit.

What information do I need to provide on the form?

You will need to provide personal details such as your name, date of birth, current and previous addresses, relationship to the inmate, and identification information. Additionally, if you have ever visited another inmate, have any criminal history, or are currently on probation or parole, you must disclose this information. It's also important to indicate if you're accompanying any minors. Be sure to fill out all sections completely to avoid complications.

How do I submit the Visiting Questionnaire form?

The form must be completed accurately and submitted directly to the visiting office of the institution where the inmate is housed. Ensure that you mail it to the correct address. It’s advisable to check with the institution if you have questions about the mailing process or any other guidelines before you send it.

What happens after I submit the Visiting Questionnaire?

Once you submit the form, the institution will review the information provided. If approved, the inmate will be informed, and they will notify you regarding the visitation. If disapproved, the institution will send you a notification by mail explaining the reasons for this decision. Remember, you cannot visit until you receive an official approval.

Common mistakes

Filling out the Visiting Questionnaire form can be a straightforward process, but several common mistakes can lead to delays or denials. One frequent error is failing to provide accurate information regarding the inmate's name and CDC number. This information must match exactly to what is on file. Inaccurate details can confuse officials and result in processing issues.

Another common oversight involves not including all requested names and details about past visits. If you have visited another inmate, it is crucial to complete the section about previous visitation accurately. Omitting this information can raise red flags and may ultimately lead to disapproval of your application.

Many individuals neglect to review their identification details carefully. The name listed on the form must match your photo identification exactly. Any discrepancies, even minor ones, could result in issues on the day of the visit or disapproval of your application altogether.

Finally, failing to address any prior criminal history can significantly impact your application. Be honest and thorough when detailing any past arrests or convictions. Not listing this information may be viewed as an attempt to falsify your application, which could lead to immediate denial. Ensuring that all sections of the form are filled out completely and truthfully is essential for a successful visit application.

Documents used along the form

The Visiting Questionnaire form is an essential document for anyone wishing to visit an inmate in a California correctional facility. Alongside this form, several other documents may be required or helpful during the visitation application process. Understanding these documents can make the process smoother.

  • Inmate Information Card: This card contains basic details about the inmate, including their name, CDC number, and facility location. It helps visitors confirm they are applying to visit the correct person.
  • Visitor Agreement Form: Visitors may need to sign an agreement outlining rules and expectations for their behavior during visits, ensuring understanding of the correctional facility's policies.
  • Photo Identification: A government-issued ID is typically required for visitors. This could be a driver's license, state ID, or passport, serving to verify the identity of the visitor.
  • Background Check Authorization Form: Some facilities may require visitors to consent to a background check. This form grants the institution permission to review any criminal history.
  • Parental Consent Form for Minors: If a visitor is under 18, they often need a signed, notarized letter from a parent or guardian granting permission for the visit.
  • Health Verification Statement: Visitors with disabilities or medical needs may need to submit a statement from their physician confirming any special requirements they have for visits.
  • Incident Report Form: If a visitor has experienced an incident during a prior visit, they might be asked to fill out a report detailing what happened for the record.
  • Denial Appeal Form: Should a visit request be denied, this form allows the applicant to formally appeal the decision and provide additional information.
  • Visiting Procedures Handbook: This handbook outlines all the rules, regulations, and procedures visitors must follow, including what to expect during the visit.
  • Mailing Receipt: It’s beneficial to keep a record of when the questionnaire was sent. A mailing receipt can serve as proof that the application was submitted.

Using these documents in conjunction with the Visiting Questionnaire form will help prepare for a visit and ensure that all requirements are met. Being organized and aware of the necessary paperwork can lead to a positive visiting experience.

Similar forms

  • Visitor Application Form: Similar to the Visiting Questionnaire, the Visitor Application Form collects personal information about the individual wishing to visit an inmate, including identification details and the relationship to the inmate. The information is used to determine eligibility to visit and may also require a background check.
  • Inmate Release Request Form: Like the Visiting Questionnaire, this form requires details about the applicant’s background, relationship to the inmate, and provides a mechanism for authorities to assess the appropriateness of the visit or release.
  • Probation Application Form: This document gathers similar personal background information and may assess the applicant's criminal history, reflecting the same concern for the safety and security of the inmate population as the Visiting Questionnaire.
  • Background Check Authorization Form: This form, which requires consent for a criminal background check, parallels the Visiting Questionnaire in that it seeks to protect institutional security by vetting visitors based on their criminal history.
  • Employment Application for Correctional Institutions: Much like the Visiting Questionnaire, this application requires detailed personal information and past criminal records, assessing an applicant's suitability for a sensitive position within a correctional facility.
  • Child Visitor Consent Form: Similar in structure, this form seeks specific information about minors wishing to visit inmates and requires consent from guardians, focusing on safety and appropriate visitation protocols.
  • Housing Assistance Application: This document also collects extensive personal and demographic information, similar to the Visiting Questionnaire. It evaluates eligibility based on the applicant's background, although in a different context—housing versus prison visitation.
  • Medical Release Authorization Form: Like the Visiting Questionnaire, this document necessitates detailed identification and potentially sensitive background information to ensure that the individual's medical history does not pose a risk to others during medical visits.

Dos and Don'ts

  • Do read the instructions carefully before starting the form.
  • Do print or type your answers clearly to avoid mistakes.
  • Do provide complete and truthful information to prevent delays.
  • Do double-check your Social Security number, if you choose to include it.
  • Do mail the form directly to the correct institution's visiting office.
  • Don't omit any previous names or relevant details regarding your criminal history.
  • Don't attempt to visit without prior approval from the institution.
  • Don't falsify any information; this can lead to denial of your visit.
  • Don't ignore the special requirements if you have a disability.

Misconceptions

Misconceptions about the Visiting Questionnaire form can lead to confusion and even denial of a visit. Here are seven common misconceptions, along with clarifications to help you navigate the process.

  1. Providing a Social Security number is mandatory.

    While the form requests your Social Security number, it is actually optional. The form clearly states that not providing this information will not necessarily lead to automatic denial of your application, but be aware that omitting it may lead to complications.

  2. Only family members can fill out the questionnaire.

    Anyone wishing to visit an inmate can complete the questionnaire, not just direct family members. Friends or other support individuals are encouraged to apply as long as they are listed appropriately on the form.

  3. All previous arrests must be reported.

    This is partially true; you must disclose serious offenses or certain convictions. However, not every minor infraction or arrest leads to denial. It’s important to list what’s required accurately and truthfully.

  4. You will be notified immediately if your application is denied.

    While the institution informs you if you are disapproved, this notification comes by mail. It may take time before the decision reaches you, so patience is essential.

  5. The questionnaire process is simple and quick.

    Although straightforward, processing your application can take time. Factors such as background checks and institutional policies may extend the duration, so it’s wise to submit your form well in advance of your intended visit.

  6. Only one questionnaire needs to be filled out for multiple visits.

    This is incorrect. A new Visiting Questionnaire must be completed for each visit request, especially if there have been changes in your information or the inmate’s status.

  7. Siblings and step-siblings don’t count as immediate family.

    In fact, the questionnaire recognizes siblings and step-siblings as valid relationships for visitation. It is important to accurately state your relationship to the inmate, as this can influence your eligibility.

Understanding these misconceptions can better prepare you for the visiting process and ensure a smoother experience. Always read the instructions on the form carefully, and don’t hesitate to reach out to the institution if you have questions.

Key takeaways

Filling out the Visiting Questionnaire for the California Department of Corrections is a crucial step for anyone hoping to visit an inmate. Understanding the process can significantly enhance your chances of approval. Here are some key takeaways to consider:

  • Complete Information: Ensure every section is filled completely and accurately. Incomplete submissions often lead to delays or disapproval.
  • Provide Identification: Use the name exactly as it appears on your government-issued photo ID to avoid discrepancies.
  • Social Security Number: While providing your Social Security number is optional, failing to complete required fields can result in a denial.
  • Mail Directly: Send the completed form directly to the institution’s visiting office. Do not send it to third parties.
  • Relationship to Inmate: Clearly state your relationship to the inmate. This information is critical to the application’s approval.
  • Prior Visits: If you have visited other inmates, include this history. It assists in establishing your credibility as a visitor.
  • Criminal History: Be honest about any arrests or convictions. This can be a reason for disapproval if omitted.
  • Disability Accommodations: If applicable, attach documentation supporting any disability needs to facilitate reasonable accommodations.
  • Approval Notification: Expect to be notified by mail regarding your approval or disapproval status. It is essential to wait for this confirmation before attempting a visit.

Following these guidelines diligently will improve your chances of successfully visiting your loved one. Take this process seriously, as the rules are in place to maintain safety and security within correctional facilities.