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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 crucial information that helps officials determine eligibility for visitation. At its core, the questionnaire requires details about both the visitor and the inmate, including names, identification numbers, and relationships. It also addresses previous criminal history, ensuring that visitors disclose any past detentions or convictions, which could impact their approval status. Additionally, the form emphasizes the importance of accuracy and honesty, as any omissions or falsifications may lead to denial of visitation rights. For those under 18, parental consent is required, and specific guidelines are provided for visitors with disabilities to ensure accessibility. The form also outlines the legal framework surrounding prison visitation, highlighting the rules and regulations visitors must adhere to, including the potential for searches upon entry. Completing the Visiting Questionnaire accurately and thoroughly is a critical step in facilitating meaningful connections between inmates and their loved ones.

Preview - 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 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

Document Specifics

Fact Name Description
Form Title The official name of the form is the "Visiting Questionnaire," specifically designated as CDC 106.
Governing Law This form is governed by the California Penal Code, specifically Sections 2772, 2790, and 4570, among others.
Privacy Act Compliance In accordance with the Privacy Act of 1974, providing a Social Security number is optional.
Submission Instructions The completed form must be mailed directly to the visiting office of the institution where the inmate is confined.
Visitor Requirements Visitors under 18 must have notarized consent from a parent or guardian and be accompanied by an approved adult.
Notification of Approval If approved, the inmate will be notified. If disapproved, the institution will inform the applicant by mail.

Visiting Questionnaire: Usage Instruction

Filling out the Visiting Questionnaire form is an important step in the process of visiting an inmate. Once you complete the form, you will need to mail it directly to the visiting office of the institution where the inmate is confined. Make sure to provide accurate information, as any omissions or inaccuracies may lead to a denial of your visiting request.

  1. Fill in the inmate's name: Write the last name, first name, and middle name, along with the inmate's CDC number.
  2. Provide your name: Print your name exactly as it appears on your photo identification. Include any suffix (e.g., Jr., Sr.) and your home telephone number.
  3. List maiden name and other names: If applicable, include your maiden name and any other names you have used. State your relationship to the inmate (e.g., spouse, son/daughter).
  4. Enter your date of birth: Fill in your birth date, gender, and birthplace (city, county, state, country).
  5. Provide identification details: Select your ID type (driver’s license, state ID, military ID, etc.) and write the ID number and issuing authority.
  6. Optional: Social Security number: If you choose to provide it, include your Social Security number and its expiration date.
  7. Current residence address: Fill in your street address, apartment number (if applicable), city, state, and ZIP code.
  8. Mailing address: If different from your residence address, provide your mailing address, including city, state, and ZIP code.
  9. Previous address: List your previous address within the past two years, including city, state, and ZIP code.
  10. Accompanying minors: If you are bringing any minors, provide their names, dates of birth, and relationships to the inmate.
  11. Previous visits: Indicate if you have visited another inmate in a California prison and provide details if applicable.
  12. Criminal history: Answer whether you have ever been detained, arrested, or convicted of a crime. If yes, list all relevant details.
  13. Probation or parole status: Answer whether you are currently on probation, parole, or under any court-imposed program.
  14. Additional requirements: If you are under 18 and not an emancipated minor, ensure you have notarized consent from a parent or guardian.
  15. Disability accommodations: If you have special requirements due to a disability, attach a verifying statement from your physician.
  16. Read and sign: Acknowledge that you understand the rules and regulations, then sign and date the form.

Learn More on Visiting Questionnaire

What is the purpose of the Visiting Questionnaire form?

The Visiting Questionnaire form is used by the California Department of Corrections to evaluate whether a visitor can be approved to visit an inmate. The information provided helps officials assess the visitor's background and relationship to the inmate, ensuring safety and security during visits.

How should I fill out the form?

Fill out the form by printing or typing your information clearly. Ensure that all sections are completed accurately. Use your full name as it appears on your photo identification. If you have previously used another name, list it in the designated section. Double-check for any omissions or inaccuracies, as these may lead to denial of your visit.

Is providing my Social Security number mandatory?

No, providing your Social Security number is optional. However, omitting or falsifying any information on the questionnaire could result in a denial of your visiting request. It is best to provide complete and truthful information to avoid complications.

Where do I send the completed form?

After completing the Visiting Questionnaire, mail it directly to the visiting office of the institution where the inmate is confined. Make sure to verify the correct mailing address for that specific facility to ensure your form is received promptly.

What happens if my visit is disapproved?

If your visit is disapproved, you will receive a notification by mail explaining the reasons for the denial. You will not be allowed to visit until your application is approved. If you believe there has been an error, you may inquire about the possibility of reapplying after addressing the issues noted in the disapproval.

What 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 have written notarized consent from a parent or legal guardian. Additionally, you must be accompanied by an adult who is also approved to visit. This consent must be presented each time you visit unless prior arrangements have been made with the Warden.

Are there special considerations for visitors with disabilities?

Yes, if you have special requirements due to a disability, you should attach a verifying statement from your physician. The California Department of Corrections aims to provide reasonable accommodations while ensuring the safety and security of the institution. Contact the facility if you have specific needs or concerns.

What are the rules regarding searches at the institution?

All visitors entering the correctional institution are subject to searches of their person, vehicle, and property. If you refuse to submit to a search, you will be denied visiting for that day. In certain situations, such as when officials have a court-issued search warrant, you may not leave the premises without complying with the search.

What should I do if I have a criminal history?

If you have a criminal history, you must disclose all detentions, arrests, and convictions on the questionnaire. Failure to do so may lead to denial of your visiting request. Be honest about your past, as this information is crucial for the approval process.

Common mistakes

Filling out the Visiting Questionnaire form correctly is crucial for ensuring a smooth visiting experience. However, many people make common mistakes that can lead to delays or even denials of their applications. Here are seven frequent errors to avoid.

One of the most common mistakes is incomplete information. Many individuals forget to fill out all required fields, such as the inmate's CDC number or their own name as it appears on their identification. Omitting essential details can result in immediate disapproval of the application.

Another frequent error involves incorrect formatting. The form specifically requests that information be printed or typed clearly. Handwritten entries that are difficult to read may lead to misunderstandings or misinterpretations of the provided information.

People often overlook the importance of accuracy when listing previous names or relationships to the inmate. Failing to disclose all names used or incorrectly identifying the relationship can raise red flags and cause the application to be denied.

Some applicants mistakenly assume that providing their Social Security number is mandatory. While it is optional, leaving it out without understanding the implications can lead to further questions or concerns from officials reviewing the form.

Another common mistake is not including necessary attachments. If you have visited other inmates or have a criminal history, additional documentation may be required. Failing to attach these sheets can result in a denial of your application.

People sometimes forget to review their answers before submitting the form. Simple typos or incorrect information can easily slip through the cracks. Taking a moment to double-check your responses can save you from unnecessary complications.

Lastly, many individuals neglect to follow submission guidelines. The form must be mailed directly to the appropriate visiting office, and failing to do so can lead to delays in processing. Ensuring that you have the correct mailing address is essential for timely approval.

Documents used along the form

When preparing to visit an inmate, it’s important to understand that the Visiting Questionnaire form is just one piece of the puzzle. Several other documents may be needed to ensure a smooth visiting process. Here’s a brief overview of some of the commonly used forms and documents that accompany the Visiting Questionnaire.

  • Photo Identification: A valid government-issued ID, such as a driver’s license or passport, is required to verify your identity when visiting.
  • Consent Form for Minors: If you are under 18 and not an emancipated minor or the inmate's legal spouse, you need a notarized consent form from a parent or guardian.
  • Discharge Paperwork: If you have recently been released from a correctional facility, you may need to provide documentation showing your discharge status.
  • Visitor Approval Notification: This document confirms whether your application to visit has been approved or denied, and will be sent to you by the institution.
  • Medical Verification Statement: If you have a disability and require special accommodations, a statement from your physician may be necessary.
  • Criminal History Disclosure: Some institutions may require you to disclose any past criminal history, which can affect your eligibility to visit.
  • Emergency Contact Form: This form provides the institution with a contact person in case of emergencies during your visit.
  • Visitor Rules Acknowledgment: You may be asked to sign a document acknowledging that you understand the rules and regulations of the visiting process.
  • Visitor Registration Form: Some facilities require a separate registration form that collects additional information about visitors.
  • Proof of Relationship: Documentation that shows your relationship to the inmate, such as a marriage certificate or birth certificate, may be required.

Each of these documents plays a vital role in the visiting process. Ensuring you have all the necessary paperwork can help avoid delays and make your visit as smooth as possible. Always check with the specific institution for their requirements, as they can vary.

Similar forms

The Visiting Questionnaire form is similar to the Visitor Application form used in many correctional facilities across the United States. Both documents require personal information about the visitor, including their relationship to the inmate, contact details, and identification. The Visitor Application also seeks to assess the visitor's criminal history, which may affect their eligibility to visit. Just like the Visiting Questionnaire, this form emphasizes the importance of accuracy and honesty in the information provided, as any discrepancies can lead to denial of visitation rights.

Another comparable document is the Inmate Visitation Request form. This form is typically filled out by inmates to request visits from specific individuals. Like the Visiting Questionnaire, it collects detailed information about the visitor, including their name, address, and relationship to the inmate. Both forms serve the purpose of ensuring that only approved individuals can visit inmates, thereby maintaining security within the facility.

The Background Check Authorization form is also similar in its purpose. This document is used to obtain permission from the visitor to conduct a background check. It collects personal information and may inquire about criminal history, much like the Visiting Questionnaire. The intent is to assess the visitor's eligibility and ensure safety within the correctional environment.

The Visitor Consent form is another relevant document. This form is often required for minors who wish to visit inmates. It gathers information about the minor and their legal guardian, similar to how the Visiting Questionnaire collects details about accompanying minors. Both forms ensure that proper consent is obtained before allowing a visit, particularly when minors are involved.

The Release of Information form is akin to the Visiting Questionnaire in that it allows for the sharing of personal information with correctional officials. This form typically requires the visitor to consent to the release of their background information, which is essential for the approval process. Both documents prioritize the verification of the visitor's identity and background to enhance security during visits.

The Inmate Release Notification form shares similarities as well. This document is used to inform visitors when an inmate is released from custody. It often requires the visitor's details, mirroring the information requested in the Visiting Questionnaire. Both forms are crucial for maintaining communication and ensuring that visitors are aware of the inmate's status.

The Visitation Rules and Regulations form is another document that aligns with the Visiting Questionnaire. This form outlines the specific rules visitors must follow when entering a correctional facility. It complements the Visiting Questionnaire by providing essential guidelines that visitors must understand and agree to, ensuring compliance with institutional policies.

Lastly, the Emergency Contact Information form is similar in that it collects vital information about who should be contacted in case of an emergency involving the visitor or the inmate. Both forms emphasize the importance of accurate and current contact information, which is critical for safety and communication within the correctional system.

Dos and Don'ts

When filling out the Visiting Questionnaire form for the California Department of Corrections, it’s important to follow specific guidelines to ensure your application is processed smoothly. Here are five things to do and avoid:

  • Do print or type all information clearly. This helps prevent misunderstandings.
  • Do provide accurate information. Any omissions or false statements may lead to denial of your visit.
  • Do include your relationship to the inmate. This information is crucial for processing your request.
  • Do attach any necessary additional sheets if you have more than one inmate to list or if you need to explain your criminal history.
  • Do mail the completed form directly to the visiting office of the institution where the inmate is confined.
  • Don't forget to include your Social Security number if you choose to provide it. It’s optional but may help in processing.
  • Don't leave any sections blank. Incomplete forms can lead to delays or disapproval.
  • Don't submit the form without checking for errors. Review your answers before mailing.
  • Don't attempt to visit if you have been disapproved previously without reapplying after the required time.
  • Don't bring prohibited items to the institution. Familiarize yourself with the rules regarding what you can and cannot bring.

Misconceptions

Misunderstandings about the Visiting Questionnaire form can lead to confusion and delays. Here are seven common misconceptions:

  • Social Security Number is Mandatory: Many believe that providing a Social Security number is required. In fact, it is optional. However, omitting it may lead to complications in processing your application.
  • Only Immediate Family Can Visit: Some think that only immediate family members can fill out the questionnaire. In reality, anyone who has a legitimate relationship with the inmate can apply to visit.
  • Approval is Guaranteed: There’s a common belief that submitting the form guarantees approval. Approval depends on the information provided and the inmate's status.
  • Past Criminal History Automatically Disqualifies You: Many fear that any past criminal history will lead to automatic disqualification. While it is a factor, each case is reviewed individually, and not all offenses will disqualify you.
  • Visitors Are Not Subject to Searches: Some people think they won’t be searched upon entering the facility. In reality, all visitors are subject to searches for security reasons.
  • Minors Can Visit Without Consent: There’s a misconception that minors can visit without parental consent. Minors must have written notarized consent from a parent or guardian and be accompanied by an approved adult.
  • Notification of Disapproval is Immediate: Many expect to be notified of disapproval right away. Instead, the institution will notify you by mail, which may take some time.

Understanding these misconceptions can help ensure a smoother application process for visiting an inmate.

Key takeaways

Filling out the Visiting Questionnaire form is a crucial step for anyone wishing to visit an inmate in a California correctional facility. Here are key takeaways to ensure a smooth application process:

  • Accurate Information is Essential: Every detail provided must be accurate and truthful. Any omissions or falsehoods can lead to denial of your visiting privileges.
  • Optional Social Security Number: While you may choose to provide your Social Security number, it is not mandatory. However, omitting other required information could jeopardize your application.
  • Submit Directly: Once completed, mail the form directly to the visiting office of the institution where the inmate is held. Do not send it to any other location.
  • Understand the Approval Process: If approved, the inmate will be notified, and it is their responsibility to inform you. In case of disapproval, you will receive written notification detailing the reasons.