The Golden Bear Pass Application form is a document intended for individuals who meet specific eligibility criteria, allowing them access to most California State Park operated units where vehicle day use fees are collected, at no charge, after a $5.00 yearly fee. This pass offers benefits to a diverse group including seniors over 62 years old with limited income, recipients of Supplemental Security Income (SSI), or individuals receiving aid under the CalWORKS program, making outdoor recreation more accessible. To learn more about the application process, eligibility, and to submit your application, click the button below.
The journey to obtaining a Golden Bear Pass, which grants access to most of California's state park-operated units, begins with the Golden Bear Pass Application form, a critical document for eligible individuals wanting to explore the natural beauty of the state without the burden of day-use fees. This is particularly valuable for those who receive Supplemental Security Income (SSI), are beneficiaries under the CalWORKS Program, or for seniors aged 62 and above with income limitations, as specified by the application’s eligibility criteria. The form, a bridge between applicants and the California State Parks, outlines a straightforward process requiring personal information, proof of eligibility through specified documents, and a nominal fee of $5.00. This process ensures that those who qualify are granted their passes, which are to be renewed yearly and come with a set of terms and conditions aimed at maximizing the utility and fairness of the pass. Distributed by the State of California - Natural Resources Agency and the Department of Parks and Recreation, the form underscores the state's commitment to making its parks accessible to a broader segment of the population, considering private information with a high degree of confidentiality and sensitivity as highlighted by the Privacy Notice. Whether submitting in person or through mail, applicants are guided through each step, with clearly stated instructions, ensuring a transparent and efficient process designed to welcome a diverse group of park visitors.
State of California - Natural Resources Agency
DEPARTMENT OF PARKS AND RECREATION
GOLDEN BEAR PASS APPLICATION
2023 Calendar Year (January - December) - Application Fee Waived
To qualify for the Golden Bear Pass, the applicant must currently receive Supplemental Security Income (SSI),
OR receive aid under the CalWORKs program (as defined below), OR be 62 and over and meet certain income limits.
A. Personal Information:
CHECK IF APPLYING TO REPLACE A LOST/STOLEN PASS FROM THIS CALENDAR YEAR.
APPLICANT NAME (Last, First, Middle Initial)(Photo ID required)
SPOUSE / REGISTERED DOMESTIC PARTNER (Photo ID required if named on pass)
PHONE NUMBER
DATE OF BIRTH
E-MAIL ADDRESS
MAILING ADDRESS / CITY / STATE / ZIP CODE
HOME STREET ADDRESS / CITY / STATE / ZIP CODE (no post office boxes)
Same as Mailing Address
APPLICANT ORIGINAL SIGNATURE (E-SIGNATURES AND PHOTOCOPIES NOT ACCEPTED)
I certify under penalty of perjury that the information provided below is true and correct.
►
VALID DRIVER LICENSE/OTHER PHOTO ID NO. (Attach copy if applying by mail)
TODAY'S DATE
B.Attach the following items to this application with sensitive/confidential information omitted:
A copy of a valid state issued driver license or photo identification (interim/temporary not accepted) issued by the state or federal government, or a current school ID.
A copy of a valid photo ID also required for spouse or registered domestic partner if named on pass.
Required documentation based on selected certification below in Section C.
C.Check one of the following boxes to indicate the provisions under which you qualify:
1.Receiving Supplemental Security Income (SSI) [CA State Welfare and Institutions Code Section 12200]. Applicant must provide a current statement of SSI benefits or current benefit verification letter from the U. S. Social Security Administration (dated within one year of application). Applicant must be at least 16 years of age.
2.Receiving aid under the CalWORKs Program under the provisions of the California State Welfare and Institutions Code beginning at Section 11200. Applicant must verify their CalWORKs case is ACTIVE in the month the Golden Bear Pass application is submitted by providing documentation from their online benefits system or the county social services agency.
3.Single, age 62 or over and average gross monthly income from all sources does not exceed $1,564.
(Complete & attach page 2)
4.Married or registered domestic partnership, primary applicant aged 62 or over and combined average gross monthly income from all sources does not exceed $2,106. (Complete & attach page 2)
ISSUING OFFICE USE ONLY
Retain applications for one year from the end of the calendar year, then destroy.
INCOME VERIFICATION TYPE
INCOME ELIGIBILITY VERIFIED BY
DATE
1
2
3
4
PASS ISSUED BY
DISTRICT/UNIT
Mail-in (HQ ONLY)
PASS NUMBER
NOTICE TO EMPLOYEES: The information entered on this form is classified as "personal" under the Information Practices Act (Civil Code Section 1798). When filing in person, supporting documents may be returned to the applicant.
DPR 578 (Rev. 11/2022)(Excel 11/30/2022)(Page 1 of 3) DO NOT DUPLICATE APPLICATION - DEPARTMENT LEGAL OFFICE SHOULD BE CONSULTED BEFORE DISCLOSURE.
2023 GOLDEN BEAR PASS APPLICATION - Continued
Income Verification
Please read thoroughly before applying under this section.
If you checked box C-3 or C-4 on page one, please choose one of the following two options for income verification, attach appropriate documentation, and complete and sign the Golden Bear Income Declaration section at the bottom of page.
I.CURRENT "REDUCED-FEE SPORT FISHING LICENSE: SENIOR - LIMITED INCOME(LI)" Issued by the California Department of Fish and Wildlife (copy attached).
If verifying under this Section (I), skip Section II and complete Declaration section at bottom.
II.DECLARATION OF TOTAL GROSS ANNUAL INCOME SOURCES *
State your income in the table below, attach documentation (must be dated within one year of application) and complete/sign the Golden Bear Income Declaration below.
Total gross income means an individual's total income before taxes or deductions. This includes ALL sources of income including but not limited to:
Salaries, commission, bonuses, social security, pensions, disbursements from retirement accounts, workers' compensation benefits, unemployment insurance benefits, rent, interest income, welfare payments, grants and educational allowances.
Total Annual Gross Income cannot exceed:
$18,768 for a single person
or
$25,272 for married persons or registered domestic partners.
Doc.
APPLICANT
SPOUSE/REG. DOMESTIC PARTNER
Income Source
Annual Gross
Attached
$
Total Annual Gross Income
Total Combined Annual Gross Income: $
*Applicant must attach any and all associated documentation providing "Proof of Income". Acceptable documents include but are not limited to: Statement of benefits from Social Security, Veterans Administration, retirement/pension, unemployment insurance benefits, and/or workers' compensation benefits; rent statements, all forms 1099 for income referenced above, Forms W2.
GOLDEN BEAR INCOME DECLARATION (must be completed and signed)
The undersigned hereby certifies, under penalty of perjury, that all information provided in this application is true and correct, and that he/she meets the Golden Bear Pass Income Limits for the year in which applying.
NAME OF APPLICANT (Last, First, Middle Initial)
NAME OF SPOUSE/REGISTERED DOMESTIC PARTNER (if applicable)
APPLICANT ORIGINAL SIGNATURE (PHOTOCOPIES NOT ACCEPTED)
ORIGINAL SIGNATURE - SPOUSE/REGISTERED DOMESTIC PARTNER (if applicable)
DPR 578 (Rev. 11/2022)(Page 2 of 3) DO NOT DUPLICATE APPLICATION - DEPARTMENT LEGAL OFFICE SHOULD BE CONSULTED BEFORE DISCLOSURE.
GOLDEN BEAR PASS PROGRAM
2023 Calendar Year (January - December)
APPLICANT'S COPY
APPLICATION INSTRUCTIONS
APPLICATION INSTRUCTIONS: (NOTE: Completed application packets with all attachments submitted by mail will be retained by California State Parks and cannot be returned.) Submit completed application and certification material with copy of valid state-issued driver license or suitable photo Identification to:
IN PERSON:
At designated locations of the CA State
Park System
(www.parks.ca.gov/passlocations -
contact in advance to ensure
availability)
TERMS AND CONDITIONS OVERVIEW
Under the law, any qualifying person receiving Supplemental Security Income (SSI) [CA State Welfare and Institutions Code Section 12200]; any person receiving aid under the applicable aid codes in the CalWORKS Program; or any person qualified as listed on page 1, Section C (3&4) in accordance with the California Family Code (beginning at Section 297) is eligible to receive the Golden Bear Pass upon application.
The Golden Bear Pass entitles the bearer and spouse or registered domestic partner entry to most California State Park operated units where vehicle day use fees are collected at no charge.
Upon receipt of the Golden Bear Pass, pass holder agrees to the Terms and Conditions of this pass; violation could result in pass revocation. For the complete list of Terms and Conditions inquire at the location of purchase or visit www.parks.ca.gov. Terms and Conditions include, but are not limited to:
Pass must be renewed each calendar year and is valid for the use of the pass holder and spouse or registered domestic partner only. Once pass is received, you may use passcard for applicable benefits.
Pass is issued as a personal benefit to the pass holder and spouse or registered domestic partner only (applicable only if spouse or registered partner is named on passcard). The pass holder may not lend, loan, reassign, or resell their pass or the privileges allowed by this pass to anyone else, including family members.
Pass holder and spouse or registered domestic partner (if applicable) must abide by any rules and regulations applicable to California State Parks or to the use of this pass, as amended from time to time.
Pass is valid for one passenger vehicle with a capacity of nine persons or less where a vehicle day use fee is collected. Not valid at units operated by federal or local government, private agencies or concessionaires. Pass may be used any day of the week, including holidays, if space is available. Admittance and use subject to available space.
Pass holder is required to present the Golden Bear Pass (photocopies not accepted) and a valid state-issued driver license or other suitable photo ID (interim/temporary not accepted) and pay any supplemental fees at the park.
To receive pass benefits at self-pay locations, pass holder must clearly display the pass & self-payment receipt on vehicle dashboard visible through the windshield. Oversized vehicle fees will not be assessed; but, not all parks can accommodate.
Pass is not valid for resale or commercial use, industrial or business operations, including, but not limited to fleet use or pooling. Pass shall not be assigned for profit and is void if misused.
Pass is not valid for per-person entry or tour fees (such as museums), boat use, camping, group use or sites, special events, additional/extra vehicle fees, sanitation disposal use or for supplemental fees.
Pass is valid unless revoked. This pass cannot be used in conjunction with any other pass and/or discount, nor can it be copied or altered in any way. Pass will be cancelled if the pass holder is found not to meet the pass qualifications.
All sales are final. No refunds, replacements or exchanges will be made for any reason including, but not limited to: loss theft, park closures or environmental conditions such as low water levels, fire, or inclement weather. A lost or damaged
pass may be replaced only through reapplication.
For any questions regarding the Golden Bear Pass, contact
CALIFORNIA STATE PARKS PASS SALES at Passinfo@parks.ca.gov.
Information on the application is considered personal. See Privacy Notice below.
PRIVACY NOTICE
Section 1798.17 of the Civil Code requires this notice be provided when collecting personal information from individuals. Each individual has the right to review personal information maintained by this agency, unless access is exempted by law.
AGENCY NAME
Department of Parks and Recreation
DIVISION
Strategic Planning and Recreation Services
TITLE OF OFFICIAL RESPONSIBLE FOR MAINTENANCE OF THE INFORMATION
Staff Services Manager II
BUSINESS ADDRESS OF OFFICIAL
CONTACT EMAIL
P.O. Box 942896, Sacramento, CA 94296-0001
passinfo@parks.ca.gov
AUTHORITY WHICH AUTHORIZES THE MAINTENANCE OF THE INFORMATION
Public Resources Code Section 5011 (added by Chapter 1303, Statutes of 1982)
THE FOLLOWING ITEMS OF INFORMATION ARE VOLUNTARY, ALL OTHERS ARE MANDATORY
All information requested on the application is mandatory.
THE CONSEQUENCES, IF ANY, OF NOT PROVIDING ALL OR ANY PART OF THE REQUESTED INFORMATION
The applicant will not be issued a Golden Bear Pass.
THE PRINCIPAL PURPOSE(S) WITHIN THE AGENCY FOR WHICH THE INFORMATION IS TO BE USED
The information will be used to determine eligibility for issuance of Golden Bear Passes allowing use of State Park operated facilities where vehicle day use fees are collected, at no further charge. Applications will be retained one calendar year from the end of the calendar year for audit purposes, statistical data, and evaluation of the program.
KNOWN OR FORESEEABLE DISCLOSURES OF THE INFORMATION PURSUANT TO CIVIL CODE SECTION 1798.24, SUBDIVISIONS (e) OR (f)
Departmental Audits Office
DPR 578 (Rev. 11/2022)(Page 3 of 3)(Instructions, Terms and Conditions, Privacy Notice)
DO NOT DUPLICATE APPLICATION
Filling out the Golden Bear Pass Application is a straightforward process designed to allow eligible individuals access to most California State Park operated units with certain benefits. By following the steps outlined below, applicants can ensure they submit a complete application packet. It's important to gather all required documents before starting to fill out the application, including state-issued identification and any certificates necessary to prove eligibility under the specified provisions.
After submitting your Golden Bear Pass Application, please expect a processing time of 4-6 weeks for applications sent by mail. Once your application is approved, you will receive your pass, granting you access under the terms and conditions specified. Ensure to familiarize yourself with these rules, such as the annual renewal requirement and the restrictions on pass use, to fully enjoy the benefits your Golden Bear Pass offers.
Who is eligible for the Golden Bear Pass?
Eligibility for the Golden Bear Pass includes three main groups: individuals receiving Supplemental Security Income (SSI), individuals receiving aid under specific CalWORKS Program aid codes, and people aged 62 or over whose monthly income does not exceed specific limits ($935 for single individuals or $1,751 for married persons or registered domestic partners).
What do I need to submit with my Golden Bear Pass application?
When applying for a Golden Bear Pass, you must submit a completed application form along with a copy of a valid state-issued driver license or other suitable photo identification, certification material proving your eligibility, and a $5.00 payment. Ensure all personal information is filled out and that any sensitive or confidential information in your certification materials is redacted.
How can I submit my Golden Bear Pass application?
You can submit your Golden Bear Pass application either in person at many units of the California State Park System (contact in advance to ensure availability) or at the Park Pass Sales Office in Sacramento. Alternatively, you may mail your completed application packet, including all required documents and payment, to the specified address. Please allow 4-6 weeks for processing if mailing your application.
What benefits does the Golden Bear Pass provide?
The Golden Bear Pass allows the pass owner and their spouse or registered domestic partner entry to most units of the California State Park System where vehicle day use fees are collected, excluding Candlestick Point State Recreation Area. It covers one passenger vehicle with a capacity of nine people or less. The pass does not cover per-person entry or tour fees, boat use, camping, group use or sites, special events, commercial use, or supplemental fees such as additional motor vehicles.
Is the Golden Bear Pass renewable, and are there any restrictions?
Yes, the Golden Bear Pass must be renewed each calendar year. It is only valid for the use of the pass owner and spouse or registered domestic partner, is non-transferable, and it cannot be used in conjunction with any other pass and/or discount. Additionally, the pass holder must present the pass along with a valid state-issued driver license or suitable photo ID when entering parks, and any supplemental fees must be paid at the park.
What if my Golden Bear Pass is lost or damaged?
If your Golden Bear Pass is lost or damaged, it can be replaced only through reapplication and payment of the $5.00 fee. All sales of the pass are final, so no refunds, replacements, or exchanges will be made for any reason including loss, theft, or park closures due to environmental conditions. It's important to carefully secure the pass to avoid needing a replacement.
Filling out forms can sometimes feel like navigating through a maze, and the Golden Bear Pass Application form is no exception. Applicants often stumble on common pitfalls that can easily be avoided. One such mistake is not including the required $5.00 payment with the application packet. This fee is crucial for processing the application, and omitting it can delay or even void the application process altogether.
Another frequent oversight is failing to attach a copy of a valid state-issued driver's license or suitable photo identification along with the application. This step is vital for verifying the identity of the applicant and ensuring that the pass is issued to the right person. Overlooking this step can result in a significant delay in receiving the Golden Bear Pass.
Additionally, applicants often miss checking one of the boxes under section B to indicate under which provision they qualify. Selecting the correct option is essential as it aligns with providing the appropriate certification materials. Without this, the application cannot be accurately assessed, leading to potential disqualification or requests for additional information.
Another common error is not providing a complete mailing address and home street address. It's important to remember that post office boxes are not acceptable for the home street address as the form explicitly requires a physical address. Inaccurate or incomplete addresses can lead to misdirected or undeliverable passes.
Many applicants also neglect to include the required certification material, as noted in the application instructions. This documentation is necessary to confirm eligibility under the stipulated provisions. Failure to provide these materials can result in an incomplete application, which cannot be processed until all required documents are received.
Furthermore, not redacting sensitive or confidential information from the supporting documents can pose a privacy risk. While the application instructions suggest redacting such information, failing to do so could lead to unintended disclosure of personal data.
Last but not least, a common mistake is not signing the application. An unsigned application is considered incomplete and cannot be processed. This seemingly small oversight can significantly delay the issuance of the Golden Bear Pass.
In summary, attention to detail is key when filling out the Golden Bear Pass Application. By avoiding these common mistakes, applicants can ensure a smoother process in obtaining their pass, leading to an enjoyable visit to the California State Parks.
The Golden Bear Pass Application is an essential form for Californians seeking reduced or waived access fees to state parks due to qualifying conditions. Alongside this application, several other forms and documents are commonly submitted to support the application. Understanding these additional requirements can streamline the process for applicants, ensuring they receive their pass with minimal delay.
Each document plays a pivotal role in the application process for the Golden Bear Pass, ensuring applicants meet the necessary criteria and receive their pass without unnecessary delays. By preparing these documents in advance, applicants can navigate the application process more efficiently, leading to quicker access to the natural wonders of California's state parks.
The Golden Bear Pass Application form shares similarities with the Disability Placard Application used by many states to issue parking permits for individuals with disabilities. Both applications require personal information, proof of identification, and documentation of qualifying conditions—in the case of the Golden Bear Pass, such conditions might include income eligibility or receipt of specific welfare benefits. Similarly, the Disability Placard Application needs medical certification or other proof of a qualifying disability. Each form provides a means for individuals to access services or benefits intended to improve their quality of life based on specific eligibility criteria.
Another parallel can be drawn with the Senior Pass Application form used by the U.S. National Park Service, which offers citizens or permanent residents aged 62 or older discounted access to recreational sites nationwide. Like the Golden Bear Pass, applicants must provide proof of age, identity, and, in some cases, pay a fee to obtain the pass. Both applications facilitate access to parks and recreational areas at a reduced cost, underscoring the governmental effort to ensure that income or age does not bar individuals from experiencing natural and cultural heritage.
The Low-Income Housing Application process, managed by various housing authorities across the country, also bears resemblance to the Golden Bear Pass Application. Both require applicants to provide personal information, prove eligibility based on income or receipt of government assistance, and submit documentation supporting their application. While serving different purposes—one for housing assistance and the other for recreational access—both forms are designed to aid individuals and families who fall under specific income brackets, ensuring equitable access to essential services and opportunities.
Finally, the application process for obtaining a Reduced Fee or No Fee State Identification Card in many states mirrors the Golden Bear Pass Application in its approach to assisting those with financial limitations. Applicants for both must submit proof of identity, residency, and eligibility criteria such as income levels or receipt of government benefits. Each application seeks to mitigate financial barriers—whether to ensure access to state identification for legal and everyday functions or to enable entry to state parks for leisure and health benefits.
When preparing to fill out the Golden Bear Pass Application form, it’s important to ensure all information provided is accurate and complete to avoid any delays or issues with the application process. Below is a list of dos and don'ts to guide you through the process:
By following these guidelines and carefully preparing your application, you increase the likelihood of a smooth and successful application process for the Golden Bear Pass, enabling access to the natural beauties and resources of California State Parks.
There are several misconceptions about the Golden Bear Pass application form that can lead to confusion. Here are four common ones clarified:
Eligibility is based solely on age. One common misconception is that the Golden Bear Pass is available only to those aged 62 and over. In reality, there are three qualifying conditions: receiving Supplemental Security Income (SSI), receiving aid under the CalWORKs Program, and being 62 or older with an income below a certain threshold. It's not just about age; income and other forms of public assistance play a role in determining eligibility.
All state parks in California accept the Golden Bear Pass. While the Golden Bear Pass grants access to most state-operated parks where vehicle day-use fees are collected, it is important to note exceptions like Candlestick Point State Recreation Area. Pass holders should check the specific park's policy in advance to avoid surprises at the gate.
You can use the pass for camping and other fees. Another misunderstanding involves the scope of the pass's benefits. The Golden Bear Pass waives vehicle day-use fees, but it does not cover camping fees, boat use charges, group site fees, or event fees. It is primarily intended for day use entry, so additional fees apply for other amenities or activities within the parks.
Personal information on the application is shared widely. Applicants may worry about the confidentiality of their personal information. However, the Privacy Notice on the application form makes it clear that the collected information is used strictly for determining eligibility and issuing the pass. Disclosure of this information is subject to legal restrictions, aimed at protecting individual privacy.
Understanding these aspects of the Golden Bear Pass application can help ensure that potential applicants are well-informed about its benefits and limitations, thereby maximizing the enjoyment of California's natural resources.
Understanding the nuances of the Golden Bear Pass application process is crucial for applicants aiming to smooth their way through securing a pass for California State Parks. Here are the key takeaways to assist you:
Applicants should also note the privacy notice attached to the application, reassuring that their personal information is kept confidential and only used for determining eligibility for the Golden Bear Pass. This ensures a level of personal data protection and outlines the individual's rights concerning the information provided on the application.
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