The Visiting Questionnaire form, officially designated as CDC 106, is a document utilized by the California Department of Corrections to assess an individual's eligibility to visit an inmate. This form collects essential information about the visitor and the inmate, ensuring compliance with institutional regulations and security protocols. To begin the process of visiting an inmate, please fill out the form by clicking the button below.
The Visiting Questionnaire form is a crucial document for anyone wishing to visit an inmate within the California Department of Corrections. This form collects essential information that helps officials assess whether a visitor is eligible to enter the facility. It requires details such as the inmate's name and CDC number, the visitor's personal information, and their relationship to the inmate. Visitors must also disclose any previous visits to other inmates, criminal history, and current legal statuses, including probation or parole. Additionally, the form addresses special considerations for visitors with disabilities, ensuring that accommodations can be made as needed. Importantly, the questionnaire emphasizes the importance of accuracy, as any omissions or false information can lead to disapproval of the visit. Once completed, the form must be mailed directly to the visiting office of the institution where the inmate is housed. Understanding the requirements and implications of this form is vital for anyone looking to maintain connections with loved ones in the correctional system.
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
Completing the Visiting Questionnaire form is a straightforward process. This form gathers essential information to facilitate the visiting process for inmates in California correctional facilities. Once the form is filled out accurately, it should be mailed directly to the institution where the inmate is located. Follow the steps below to ensure all necessary information is provided correctly.
After completing the form, review it to ensure all sections are filled out accurately. Once confirmed, mail it directly to the visiting office of the institution where the inmate is confined. You will receive notification regarding your application status, whether it is approved or disapproved.
The Visiting Questionnaire form is used by the California Department of Corrections (CDC) to assess whether a visitor is eligible to visit an inmate. The information provided helps officials determine if your application will be approved or denied. It's crucial to fill out the form accurately, as any omissions or false information may result in denial of visiting privileges.
Providing your Social Security number is optional. According to the Privacy Act of 1974, you can choose not to include it. However, keep in mind that omitting or falsifying any information on the form could lead to denial of your visiting application.
If you have special requirements due to a disability, such as needing mobility assistance or medical devices, you must attach a verifying statement from your physician. The CDC aims to accommodate visitors with disabilities while ensuring the safety and security of the institution. If you have any questions, reach out to the institution where the inmate is located.
If your application is approved, the inmate will be notified, and it is their responsibility to inform you. If your application is disapproved, the institution will send you a notification by mail. You will not be allowed to visit until your application receives approval.
Filling out the Visiting Questionnaire form can be a straightforward process, but there are common mistakes that can lead to delays or denials. One major error occurs when individuals fail to provide complete information. Each section of the form is crucial for the approval process. Omitting details like the inmate’s CDC number or your own identification can raise red flags and potentially result in a denial. Always double-check that all fields are filled out completely before submitting.
Another frequent mistake is using incorrect or inconsistent names. It’s essential to print your name exactly as it appears on your photo identification. If you have ever used another name, it’s important to list that as well. Inconsistencies can lead to confusion and may cause your application to be rejected. Make sure to include any maiden names or aliases to avoid complications.
People often overlook the importance of providing accurate dates. This includes your date of birth and the dates related to any previous visits or legal issues. Incorrect dates can lead to misunderstandings or indicate a lack of attention to detail, which may affect your chances of approval. Always verify that the dates you provide are correct and formatted properly.
Lastly, many applicants neglect to read the instructions carefully. The form includes specific requirements, such as the need for notarized consent for minors or verification of any disabilities. Ignoring these details can lead to unnecessary delays. Take the time to read through the entire form and ensure that you understand what is required. Being thorough can save you time and stress in the long run.
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 to ensure a smooth visiting process. Here are four commonly used forms and documents that accompany the Visiting Questionnaire.
Being prepared with these documents can help facilitate the visiting process and avoid any potential delays. Always check with the specific institution for any additional requirements or changes to the visiting policy.
The Visiting Questionnaire form shares similarities with several other documents used in various contexts. Each of these documents serves a specific purpose in gathering personal information, verifying identity, or assessing eligibility for participation in specific activities. Below is a list of nine documents that are similar to the Visiting Questionnaire form:
When filling out the Visiting Questionnaire form for the California Department of Corrections, there are several important guidelines to keep in mind. Following these guidelines can help ensure a smoother application process. Here are eight things to do and not do:
By adhering to these guidelines, applicants can help facilitate a more efficient review process and increase the likelihood of approval for visitation.
Misconception 1: The Visiting Questionnaire is optional for all visitors.
Many people believe that filling out the Visiting Questionnaire is merely a suggestion. In reality, it is a required form that must be completed to determine eligibility for visiting an inmate. Without this form, you will not be allowed to visit.
Misconception 2: Providing a Social Security number is mandatory.
Some individuals think that they must provide their Social Security number on the form. However, according to the Privacy Act of 1974, it is optional. Omitting this information will not automatically disqualify your application, but it is important to provide accurate information to avoid potential issues.
Misconception 3: If the form is submitted, a visit is guaranteed.
It's a common belief that submitting the Visiting Questionnaire guarantees a visit with the inmate. This is not true. The institution will review the questionnaire, and approval is based on various factors, including the applicant's background and any potential security concerns.
Misconception 4: Minors can visit without any special requirements.
Some may assume that minors can visit inmates freely. In fact, if a visitor is under 18 and not emancipated or the inmate’s legal spouse, they must have notarized consent from a parent or guardian. Additionally, a responsible adult must accompany them, ensuring that all legal requirements are met for the visit to occur.
Filling out the Visiting Questionnaire form for the California Department of Corrections is a crucial step in the process of visiting an inmate. Here are some key takeaways to ensure you complete it accurately and understand its importance:
By following these guidelines, you can help ensure a smoother process for your visit to the inmate. Always remember that accurate and honest information is key to gaining approval.