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The Visiting Questionnaire form is an essential document for anyone wishing to visit an inmate in a California correctional facility. This form collects critical information to help officials determine eligibility for visitation. It requires details such as the inmate's name and CDC number, as well as the visitor's personal information, including their full name, date of birth, and identification type. The form also asks about any previous visits to other inmates, criminal history, and current legal status. Visitors under 18 years of age must provide notarized consent from a parent or guardian. Additionally, the form includes provisions for individuals with disabilities, ensuring that accommodations can be made. It’s important to note that providing a Social Security number is optional, but any inaccuracies or omissions could lead to denial of visitation. Finally, the completed form must be mailed directly to the visiting office of the institution where the inmate is located, and approval or disapproval will be communicated to the applicant.

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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
➤ PDF File

Form Specifications

Fact Name Description
Purpose of the Form The Visiting Questionnaire is used by the California Department of Corrections to decide if a visitor can visit an inmate.
Privacy Information Providing your Social Security number is optional. However, not including it or giving false information can lead to denial of visiting.
Mailing Instructions This form must be mailed directly to the visiting office of the institution where the inmate is located.
Governing Laws Relevant laws include California Penal Code Sections 2772, 2790, and 4570, which address prison visitation and related offenses.

Visiting Questionnaire: Usage Guidelines

Filling out the Visiting Questionnaire form is an important step in the process of visiting an inmate. Follow these steps carefully to ensure your application is complete and accurate.

  1. Identify the inmate: Write the name of the inmate you want to visit, including their last, first, and middle names, along with the inmate’s CDC number.
  2. Provide your information: Print your name as it appears on your photo ID, include any suffix, and your home telephone number.
  3. List your maiden name: If applicable, provide your maiden name and any other names you have used.
  4. Detail your relationship: State your relationship to the inmate (e.g., spouse, son/daughter).
  5. Fill in personal details: Include your date of birth, gender, and birthplace (city, county, state, country).
  6. Provide ID information: Indicate your ID number and type (e.g., driver’s license, state ID) and the issuing authority.
  7. Social Security number: Optionally, provide your Social Security number and its expiration date.
  8. Current residence: Write your complete street address, including apartment number, city, state, and ZIP code.
  9. Mailing address: If different from your residence, provide your mailing address, city, state, and ZIP code.
  10. Previous address: List your previous address within the last two years, including city, state, and ZIP code.
  11. Accompanying minors: If applicable, provide the names, dates of birth, and relationships to the inmate for any minors accompanying you.
  12. Previous visits: Indicate if you have visited another inmate in a California prison and provide details if applicable.
  13. Criminal history: Answer whether you have ever been detained, arrested, or convicted of a crime and provide details if necessary.
  14. Probation or parole: Indicate if you are currently on probation, parole, or under any court-imposed program.
  15. Disability requirements: If you have special requirements due to a disability, indicate this and attach a verifying statement from your physician.
  16. Signature: Sign and date the form to verify that you have read and understood the information provided.

Once you have completed the form, mail it directly to the visiting office of the institution where the inmate is confined. Keep in mind that you will receive notification regarding the approval or disapproval of your visit.

Your Questions, Answered

What is the purpose of the Visiting Questionnaire form?

The Visiting Questionnaire form is used by the California Department of Corrections (CDC) to evaluate and determine whether an individual can visit an inmate. The information provided helps ensure the safety and security of both visitors and inmates.

Is it mandatory to provide my Social Security number?

Providing your Social Security number is optional. However, omitting or providing false information on the questionnaire may lead to the denial of your visiting request.

Where should I send the completed Visiting Questionnaire?

You should mail the completed form directly to the visiting office of the institution where the inmate is confined. Ensure that you have the correct address to avoid any delays in processing your request.

What happens if my visiting request is disapproved?

If your request is disapproved, the institution will notify you by mail. You will not be allowed to visit until your application has been approved. You may reapply after addressing the reasons for disapproval.

Do I need consent 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.

What should I do if I have a disability?

If you have special requirements related to your disability, you need to attach a verifying statement from your physician. The CDC will strive to provide reasonable accommodations while maintaining the safety and security of the institution.

Can I visit if I have a criminal history?

What items am I prohibited from bringing to the visit?

You are prohibited from bringing firearms, drugs, or any items that could assist an inmate in escaping. Additionally, giving or receiving gifts to or from inmates is not allowed. Violating these rules can lead to criminal charges.

How will I know if my visit is approved?

If you are approved to visit, the inmate will be notified, and it will be their responsibility to inform you. If disapproved, you will receive written notification from the institution.

Common mistakes

  1. Incomplete Information: One common mistake is failing to fill out all required fields. Each section of the Visiting Questionnaire is important. Omitting details, such as the inmate's CDC number or your relationship to the inmate, can lead to delays or even denial of your visit.

  2. Incorrect Identification: Providing inaccurate identification details is another frequent error. Ensure that your name matches exactly with the photo identification you plan to use. Discrepancies can cause confusion and may result in your application being rejected.

  3. Failure to List Previous Visits: Not mentioning past visits to other inmates can be problematic. If you have visited other inmates, it's essential to disclose this information. This helps officials assess your history and can impact your approval status.

  4. Ignoring Legal Obligations: Some applicants overlook the importance of disclosing any criminal history. If you have been detained or convicted of a crime, this must be accurately reported. Failing to do so may lead to denial of your visit and potential legal consequences.

Documents used along the form

When completing the Visiting Questionnaire form for the California Department of Corrections, several additional documents may be required to ensure a smooth application process. Each of these documents serves a specific purpose and helps verify the information provided in the questionnaire. Below is a list of commonly used forms and documents that may accompany the Visiting Questionnaire.

  • Photo Identification: A valid photo ID is necessary to confirm your identity. Acceptable forms include a driver's license, state ID, or passport. This helps the institution ensure that the visitor matches the information provided in the questionnaire.
  • Consent Form for Minors: If the visitor is under 18 and not an emancipated minor or the inmate’s legal spouse, a notarized consent form from a parent or legal guardian is required. This document ensures that minors have permission to visit and outlines any specific conditions that must be met.
  • Verification of Disability Needs: If the visitor has a disability and requires special accommodations, a statement from a physician may be necessary. This document helps the institution prepare for any specific needs, ensuring a comfortable visiting experience.
  • Discharge Documentation: For individuals recently released from incarceration, providing discharge paperwork may be required. This is particularly important for those who have been under probation or parole, as prior approval from the Warden is necessary before visiting.

Gathering these documents in advance can help streamline the approval process for visiting an inmate. Ensure that all information is accurate and complete to avoid any delays or disapprovals. If you have any questions regarding the requirements, it is advisable to contact the institution directly for clarification.

Similar forms

  • Visitation Application Form: Similar to the Visiting Questionnaire, this form collects personal information about individuals seeking to visit inmates. It typically requires details such as the visitor's name, relationship to the inmate, and any prior visitation history, ensuring that all necessary information is available for approval.
  • Background Check Authorization Form: This document is used to obtain permission to conduct a background check on the visitor. Like the Visiting Questionnaire, it emphasizes the importance of transparency and honesty, as any discrepancies may lead to disapproval of visitation rights.
  • Inmate Release Notification Form: This form notifies individuals when an inmate is released from custody. It shares similarities with the Visiting Questionnaire in that it requires accurate identification of the inmate and the notifier, ensuring that the correct parties are informed about changes in an inmate's status.
  • Visitor Registration Form: This document serves to register visitors at correctional facilities. Much like the Visiting Questionnaire, it collects personal information and requires verification of identity, helping to maintain security protocols within the institution.
  • Consent for Minor Visitors Form: When minors wish to visit an inmate, this form is necessary to ensure that proper consent is obtained from a parent or guardian. This aligns with the Visiting Questionnaire's requirement for parental consent in certain situations, emphasizing the protection of minors during visitation.
  • Emergency Contact Information Form: This form gathers information about whom to contact in case of an emergency involving the visitor or inmate. Similar to the Visiting Questionnaire, it requires accurate and up-to-date contact details, ensuring that all parties can be reached when necessary.

Dos and Don'ts

When filling out the Visiting Questionnaire form, consider the following guidelines to ensure a smooth process:

  • Do print or type your information clearly to avoid any misunderstandings.
  • Do provide accurate and complete information, especially regarding your relationship to the inmate.
  • Do include your current residence address and mailing address if different.
  • Don't omit your Social Security number, even though it is optional; any omission may lead to denial.
  • Don't provide false information, as this can result in disapproval of your visit.
  • Don't forget to attach any necessary documentation, such as consent forms for minors or medical verification for disabilities.
  • Don't assume that prior visits to other inmates will not be questioned; always disclose this information.

Misconceptions

Misconceptions about the Visiting Questionnaire Form

  • Misconception 1: The form is optional for all visitors.

    • This is incorrect. Completing the Visiting Questionnaire is mandatory for anyone wishing to visit an inmate. Failure to submit the form will result in denial of visiting privileges.

  • Misconception 2: Providing a Social Security number is required.

    • While the form requests a Social Security number, it is optional. However, omitting or falsifying any information can lead to disapproval.

  • Misconception 3: The information is not confidential.

    • The information provided is kept confidential and is maintained in a file pertaining to the inmate. Privacy is taken seriously under the Privacy Act of 1974.

  • Misconception 4: All visitors will be approved without background checks.

    • Approval is contingent upon a thorough review of the information provided, including any criminal history. Those with certain offenses may be disapproved.

  • Misconception 5: Minors can visit without any restrictions.

    • Minors must have written consent from a parent or guardian and be accompanied by an approved adult. This rule is in place to ensure the safety of all involved.

  • Misconception 6: Visitors can bring gifts or items for inmates.

    • Bringing gifts or items to inmates is prohibited and can result in criminal charges. Visitors must adhere strictly to the institution's rules regarding what can be brought into the facility.

  • Misconception 7: Visitors will be notified immediately of their approval status.

    • Notification is not immediate. If approved, the inmate will be informed, and it is their responsibility to relay that information. If disapproved, the visitor will receive a notification by mail.

Key takeaways

The Visiting Questionnaire form is an essential document for individuals wishing to visit inmates in California correctional facilities. Properly completing this form can significantly impact the approval process. Here are five key takeaways regarding its use:

  • Accuracy is Crucial: All information provided must be accurate and truthful. Any omissions or falsifications can lead to denial of visiting privileges.
  • Optional Information: Providing a Social Security number is optional, as per the Privacy Act of 1974. However, including it may assist in the processing of the application.
  • Submission Process: The completed form must be mailed directly to the visiting office of the institution where the inmate is confined. Ensure it is sent to the correct address.
  • Approval Notification: If approved, the inmate will be notified, and it is their responsibility to inform the visitor. Conversely, disapproval notifications will be sent via mail.
  • Visitor Requirements: Visitors under 18 years of age must have notarized consent from a parent or legal guardian, along with being accompanied by an approved adult.