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The Visiting Questionnaire form, officially known as CDC 106, plays a crucial role in the process of visiting inmates within California's correctional facilities. This document is not just a formality; it serves as a gateway for family and friends to maintain vital connections with incarcerated individuals. The form requires detailed information about both the visitor and the inmate, including names, relationships, and identification details. Visitors must provide personal information such as their date of birth, gender, and current residence, while also disclosing any past criminal history. It's important to note that providing a Social Security number is optional, in compliance with privacy laws. This form must be submitted directly to the visiting office of the institution where the inmate is held. Additionally, it includes guidelines for minors visiting inmates, special requirements for individuals with disabilities, and crucial legal information regarding search protocols and prohibited items. Understanding the requirements and implications of this form is essential for anyone looking to navigate the visiting process successfully.

Sample - Visiting Questionnaire Form

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

 

 

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
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Form Information

Fact Name Description
Purpose The Visiting Questionnaire is used by the California Department of Corrections to assess visitor eligibility for inmate visits.
Privacy Act Compliance Information collected is maintained in accordance with the Privacy Act of 1974, making the provision of Social Security numbers optional.
Submission Process The completed form must be mailed directly to the visiting office of the institution where the inmate is confined.
Legal Consequences Failure to provide accurate information may result in denial of visiting privileges, as stated in the form.
Governing Laws The form is governed by various sections of the California Penal Code, including Sections 2772, 2790, and 4570.

Detailed Guide for Filling Out Visiting Questionnaire

Filling out the Visiting Questionnaire form is an important step in the process of visiting an inmate in a California correctional facility. Completing this form accurately ensures that your application will be reviewed efficiently. After submitting the form, the institution will notify you whether your request to visit has been approved or disapproved.

  1. Provide Inmate Information: Fill in the name of the inmate you wish to visit, including their last name, first name, middle name, and CDC number.
  2. Enter Your Information: Print your name as it appears on your photo ID. Include any suffix, your home telephone number, and your maiden name if applicable.
  3. List Other Names: If you have ever used another name, provide that information along with your relationship to the inmate.
  4. Fill in Personal Details: Include your date of birth, gender, and birthplace (city, county, state, country).
  5. Provide ID Information: Indicate your ID number and type (e.g., driver's license, military ID). Specify the issuing authority.
  6. Social Security Number: Enter your Social Security number if you choose to provide it, along with the expiration date of your ID.
  7. Current Residence: Write your current street address, apartment number (if applicable), city, state, and ZIP code.
  8. Mailing Address: If different from your residence, provide your mailing address, city, state, and ZIP code.
  9. Previous Address: List your previous address within the past two years, including apartment number, city, state, and ZIP code.
  10. Accompanying Minors: If applicable, provide the names, dates of birth, and relationships to the inmate for any minors accompanying you.
  11. Prior Visits: Indicate whether you have visited another inmate in a California prison. If yes, complete the additional section with inmate names and relationships.
  12. Criminal History: Answer whether you have ever been detained, arrested, or convicted of a crime. If yes, provide details in the additional section.
  13. Probation or Parole: Indicate if you are on probation, parole, or under any court-imposed program. If yes, provide details.
  14. Minor Consent: If you are under 18 and not an emancipated minor or the inmate’s legal spouse, ensure you have notarized consent from a parent or guardian.
  15. Disability Accommodations: If you have a disability, attach a statement from your physician verifying your needs for accommodations.
  16. Read and Sign: Review the entire form for accuracy, sign it, and date it. Ensure you mail it directly to the institution's visiting office.

Obtain Answers on Visiting Questionnaire

  1. What is the purpose of the Visiting Questionnaire form?

    The Visiting Questionnaire form is used by the California Department of Corrections to assess whether an individual can be approved to visit an inmate. The information collected helps officials evaluate the applicant's background and relationship to the inmate.

  2. Is it mandatory to provide my Social Security number?

    Providing your Social Security number is optional. However, omitting or falsifying any information on the questionnaire may lead to denial of your visiting request. It is important to be truthful and thorough when completing the form.

  3. What happens if my Visiting Questionnaire is disapproved?

    If your application is disapproved, the institution will notify you by mail. You will not be permitted to visit the inmate until your application has been approved. Reasons for disapproval will be outlined in the notification you receive.

  4. Are there special requirements for visitors with disabilities?

    Yes, visitors with disabilities may need to provide documentation from a physician regarding their specific requirements. This could include information about medical devices or mobility aids. The Department of Corrections aims to provide reasonable accommodations while ensuring the safety and security of the institution.

  5. What should I do if I am under 18 years old?

    If you are under 18 and not an emancipated minor or the inmate's legal spouse, you must obtain written notarized consent from a parent or legal guardian. Additionally, you must be accompanied by an approved adult during the visit. This consent must be presented each time you visit unless prior approval has been granted by the Warden.

Common mistakes

Filling out the Visiting Questionnaire form correctly is essential for a successful application. One common mistake people make is failing to provide complete and accurate information. Incomplete answers or inaccuracies can lead to delays or outright disapproval. For instance, if an individual neglects to include their full name as it appears on their identification, this could result in confusion and complications during the approval process.

Another frequent error is overlooking the need for supporting documentation. Certain sections of the form require additional information or attachments, such as proof of discharge for those recently released from custody. If this documentation is not included, the application may be denied. It is crucial to read the instructions carefully and ensure that all necessary papers accompany the questionnaire.

Many applicants also mistakenly ignore the requirement for notarized consent when minors are involved. If a visitor is under 18 and not an emancipated minor or the inmate’s legal spouse, they must have written consent from a parent or guardian. Failing to provide this consent could prevent the minor from visiting the inmate, regardless of the other information provided.

Lastly, individuals often neglect to follow up on their application status. After submitting the form, it is advisable to confirm that it has been received and is being processed. If an application is disapproved, knowing the reasons for denial can help applicants correct mistakes and reapply. Understanding the process can save time and effort in securing a visit.

Documents used along the form

The Visiting Questionnaire form is an essential document for individuals seeking to visit inmates in California correctional facilities. Alongside this form, several other documents are commonly utilized to facilitate the visiting process. Each of these documents plays a specific role in ensuring that the visitation complies with the regulations set forth by the California Department of Corrections.

  • Visitor Consent Form: This document is required when a visitor is under 18 years of age and not an emancipated minor. It must be notarized and signed by a parent or legal guardian, granting permission for the minor to visit the inmate.
  • Identification Documents: Visitors must present valid identification, such as a driver’s license or state ID, to verify their identity. This helps ensure that only authorized individuals are allowed to visit inmates.
  • Discharge Papers: If a visitor has been recently released from incarceration, they may need to provide discharge paperwork. This documentation is necessary to confirm their eligibility to visit, particularly if they were released within the last twelve months.
  • Special Needs Accommodation Request: Individuals with disabilities may need to submit a request for accommodations, detailing their specific needs. This ensures that the facility can provide appropriate support during the visit.
  • Criminal History Disclosure Form: Some institutions may require visitors to disclose any past criminal history. This form helps the institution assess the security risks associated with allowing a particular individual to visit an inmate.

In summary, these documents work together with the Visiting Questionnaire to create a comprehensive system for managing inmate visitations. Each form serves a distinct purpose, ensuring that the visiting process is safe, secure, and compliant with institutional regulations.

Similar forms

The Visiting Questionnaire form serves a specific purpose in the context of prison visitation. However, several other documents share similarities in terms of the information they collect and their intended use. Here are five such documents:

  • Visitor Application Form: Like the Visiting Questionnaire, this form gathers personal information about the visitor, including identification details and relationship to the inmate. It is also used to determine eligibility for visitation.
  • Inmate Information Form: This document collects data about the inmate, such as their name, CDC number, and facility location. It aids in verifying the inmate's identity and ensuring proper record-keeping.
  • Background Check Authorization Form: Similar to the Visiting Questionnaire, this form requires visitors to disclose any criminal history. It helps officials assess the visitor's suitability for visiting an inmate.
  • Consent Form for Minors: This form is required when a minor wishes to visit an inmate. It collects information about the minor and their guardian, ensuring that proper consent is obtained, akin to the consent requirements in the Visiting Questionnaire.
  • Medical Release Form: This document requests health-related information from visitors, particularly those with disabilities. It parallels the Visiting Questionnaire's request for special requirements related to disabilities, ensuring accommodations can be made.

Dos and Don'ts

When filling out the Visiting Questionnaire form, it’s crucial to ensure that the information you provide is accurate and complete. Here are some key dos and don'ts to keep in mind:

  • Do: Print or type your answers clearly to avoid any misunderstandings.
  • Do: Double-check that all required fields are filled out, including the inmate’s CDC number and your relationship to the inmate.
  • Do: Include your Social Security number if you feel comfortable, but remember that it’s optional.
  • Do: Mail the completed form directly to the institution’s visiting office without delay.
  • Don't: Leave any sections blank. Omissions may lead to denial of your visiting request.
  • Don't: Provide false information. Misrepresentation can result in disapproval.
  • Don't: Forget to include your current residence address and any previous addresses within the last two years.
  • Don't: Attempt to visit without prior approval if you have been discharged from an institution in the last twelve months.

By following these guidelines, you can enhance your chances of a successful application. Remember, the goal is to ensure a smooth process for everyone involved.

Misconceptions

Misconceptions about the Visiting Questionnaire form can lead to confusion and frustration. Here are ten common misunderstandings, along with clarifications:

  • It's mandatory to provide my Social Security number. Providing your Social Security number is optional. However, omitting important information may lead to denial of your visit.
  • Once I submit the form, I will automatically be approved to visit. Approval is not guaranteed. The institution will review your questionnaire and notify you of the decision.
  • All visitors are treated the same, regardless of their background. Each visitor's history is evaluated. Previous arrests or convictions can affect your eligibility.
  • Minor visitors do not need consent from a parent or guardian. If you are under 18 and not an emancipated minor, you must have written consent from a parent or guardian.
  • Providing false information will only result in a warning. Falsifying information on the questionnaire can lead to denial of visiting privileges.
  • My previous visits to other inmates do not matter. The form asks about prior visits because they can influence your approval status.
  • I can visit without any identification. You must provide valid identification as specified on the form.
  • Visitors with disabilities will not be accommodated. The institution is committed to providing reasonable accommodations for visitors with disabilities.
  • Once approved, I can visit anytime. Visits are subject to scheduling and institutional rules. Approval does not guarantee immediate access.
  • Searches at the institution are optional. Visitors are subject to searches. Refusing a search can result in being denied entry for that day.

Understanding these points can help ensure a smoother visiting experience. If you have any questions, reach out to the institution for guidance.

Key takeaways

Filling out the Visiting Questionnaire form is an important step for anyone wishing to visit an inmate in a California correctional facility. Here are some key takeaways to keep in mind:

  • Complete Accuracy is Crucial: Ensure that all information provided is accurate and complete. Any omissions or false information may lead to denial of your visiting request.
  • Optional Information: While providing your Social Security number is optional, it is advisable to include it for identification purposes, unless you have concerns about privacy.
  • Mailing Instructions: Send the completed form directly to the visiting office of the institution where the inmate is located. Do not send it to any other address.
  • Requirements for Minors: If you are under 18, you must have notarized consent from a parent or legal guardian, along with a responsible adult who is approved to visit.
  • Understand the Search Policy: Visitors are subject to searches upon entering the facility. Refusal to comply with a search will result in denial of visitation for that day.

By following these guidelines, you can help ensure a smoother process for your visit. Remember, the goal is to maintain a safe and secure environment for both visitors and inmates.