The Visiting Questionnaire form, known as CDC 106 and revised in January 2003, serves as an essential tool for the California Department of Corrections (CDC) to determine eligibility for visitor approval. This document requires comprehensive information from potential visitors to maintain inmate files and ensure institutional security. By considering privacy laws, such as the Privacy Act of 1974, the form balances the need for thorough vetting with respect for individual privacy rights. If you plan to visit an inmate, ensuring accurate and complete information on your Visiting Questionnaire is pivotal. Click the button below to start filling out your form.
The Visiting Questionnaire, an essential form from the State of California Department of Corrections, is a crucial document for those seeking to visit inmates within the state's penal system. Tailored to collect detailed personal information from the prospective visitor, this form requires precise input on identity, relation to the inmate, and legal background to ensure security and compliance with institutional policies. The Visiting Questionnaire encompasses various sections, including personal identification details, residence history, accompanying minors, and a self-disclosure segment on the visitor's criminal background, probation, or parole status. By mandating the disclosure of such sensitive information, the form plays a pivotal role in the decision-making process, determining the eligibility for visitation. Moreover, it highlights the legal implications and responsibilities of a visitor, underscoring the prohibition of contraband and the importance of adhering to the rules governing interactions with inmates. Designed with both safety and procedural thoroughness in mind, the completion and submission of this form are preliminary steps that precede any authorized visit, thereby facilitating a controlled environment that respects the rights of all parties involved and the broader mandates of the California Department of Corrections.
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
Once you've decided to fill out the Visiting Questionnaire form, it's important to follow the instructions carefully to ensure your application is processed smoothly. This form is essential in facilitating visitation rights and should be filled out with accurate and honest information. The steps below outline how to complete the form. After submission, the institution will review your application. Approval or denial of visitation rights will be communicated to both you and the inmate. Should there be a need for further clarification or additional information, you will be contacted. The process aims to maintain the safety and security of all parties involved while supporting the continued connection between inmates and their loved ones.
Your application is a step towards maintaining connections and supporting rehabilitation processes. Proper completion of the Visiting Questionnaire ensures a smoother evaluation process, helping institutions make informed decisions while maintaining safety and security standards.
What information is required to fill out the Visiting Questionnaire form?
When completing the Visiting Questionnaire form, it's essential to provide detailed information to ensure a thorough review process. Required information includes the inmate's full name and CDC number, your full name as it appears on your photo ID, relationship to the inmate, and contact details. Additionally, details about your birth date, gender, ID number and type, social security number (optional), current and past addresses, and any minors that will accompany you need to be included. If you have visited other inmates, been detained, arrested, or convicted of a crime, are on probation, parole, or any court-imposed program, these details must also be disclosed. Any omission or falsification may result in the denial of visiting privileges.
Can I visit if I was recently incarcerated or am currently on probation/parole?
Yes, individuals who were recently incarcerated or are currently on probation or parole can apply for visiting privileges. However, if you were discharged from an institution or discharged from parole or outpatient status within the last 12 months, you must obtain prior written approval from the Warden. Additionally, you must attach a copy of your discharge paperwork with the Visiting Questionnaire. Detailed information regarding your probation or parole status, including the supervising agency's name, address, and telephone number, must be provided for further consideration.
How will I know if my visiting application is approved or disapproved?
After your Visiting Questionnaire has been reviewed, the institution will notify you of the outcome via mail. If your application is approved, it's the inmate's responsibility to inform you. Conversely, if your application is disapproved, both you and the inmate will be notified in writing, detailing the reasons for disapproval. It's important to ensure that all required information is provided accurately to avoid delays or denials in the approval process.
What accommodations are available for visitors with disabilities?
The California Department of Corrections is committed to providing reasonable accommodations for all qualified/eligible visitors with disabilities, in compliance with safety and security regulations. If you require special arrangements due to a disability, such as those for medical implants, prosthetic devices, mobility assistive devices, or if you're bringing a guide dog, you must attach a verifying statement from your physician to your Visiting Questionnaire. Additionally, certification paperwork for guide dogs must be presented upon visit check-in. Should you have any questions or concerns regarding accommodations, you're encouraged to contact the institution where the inmate is confined directly.
Filling out the Visiting Questionnaire form for the California Department of Corrections requires careful attention to detail and honesty. Many people inadvertently make mistakes that can delay or even prevent them from gaining approval to visit an inmate. One common mistake is not printing or typing clearly. It's crucial for the information provided to be legible to avoid confusion or delays in processing the questionnaire.
Another frequent oversight is not using the exact name and identification that matches the visitor's photo ID. The form specifically requests that you print your name as it appears on the photo identification you will be using for visiting. If the names do not match precisely, it could lead to denial of the visit request.
Some people also forget to provide all necessary details regarding past criminal history, including detentions, arrests, or convictions. The form explicitly asks for a complete listing of these incidents. Failure to disclose all requested information can result in the denial of visiting privileges. The form offers the option to attach additional sheets if more space is needed, and it is important to utilize this if your history cannot be contained within the space provided.
Not attaching required additional documentation is another error visitors make. For instance, if you've visited other inmates in a California prison, or if you have a special accommodation request due to a disability, you're required to attach additional information or verification. Overlooking these details can stall the approval process.
Misunderstanding the need for notarized consent for minors who wish to visit is a mistake as well. If a visitor is under 18 and not an emancipated minor or the inmate’s legal spouse, the minor must have notarized written consent from a parent or legal guardian. Each visit requires this documentation unless prior approval from the Warden has been obtained, a detail that is often missed, leading to confusion and potential denial at the time of the visit.
Finally, a common error is not realizing the importance of the statement at the end of the questionnaire regarding understanding and agreeing to follow all Federal, State, and CDC rules and regulations. This affirmation is crucial and must be signed by the visitor knowingly. Any indication of not understanding or agreeing to these terms can result in disapproval. Ensuring you have read, understood, and agree to all terms and conditions is vital for a smooth visiting process.
When preparing for a visit to an inmate in a correctional facility, it's crucial to be thorough in the documentation you provide to ensure a smooth application process. In addition to the Visiting Questionnaire, several other forms may be required or highly recommended to support your application. These documents further authenticate your identity, relationship with the inmate, and eligibility to visit, thereby streamlining the approval process.
Having these documents prepared and understanding their importance can greatly enhance the visiting experience, ensuring compliance with facility regulations and minimizing potential delays or denials. It's always wise to contact the correctional facility directly for the most current list of required documents, as requirements can vary significantly from one institution to another.
The Visiting Questionnaire form shares similarities with an Employment Application, primarily in its thorough background check process. Just as the Visiting Questionnaire requests detailed personal information, including previous addresses and criminal history, an Employment Application form requires similar data to verify the candidate's identity and ensure they meet the job's requirements. Both documents ask for information on past convictions or detentions, aiming to assess the applicant's suitability—whether for a job position or for the privilege of prison visitation.
Another document resembling the Visiting Questionnaire is a Tenant Application form used by landlords or property management companies. This form, like the Visiting Questionnaire, collects detailed personal information, including current and previous residences, to assess the applicant's reliability and eligibility. The Tenant Application often requires a background check comparable to the questionnaire's inquiries into criminal history to safeguard the property and its occupants.
A similar document is the Visa Application form required for entering another country. Visa Applications demand extensive personal information, reasons for travel, and past international travel history, akin to the Visiting Questionnaire's detailed questioning to determine visiting eligibility. Both applications include questions regarding criminal history to ensure the applicant's compatibility with the institution's safety and security standards.
Lastly, the Visiting Questionnaire mirrors the Personal Background Check form often used when applying for certain licenses or certifications. This form requires the disclosure of detailed personal information, including any criminal record, to evaluate the individual’s suitability for a specific professional or legal status. Both this and the Visiting Questionnaire undertake comprehensive checks to ensure the individuals meet the specific requirements or standards set by the governing body or institution.
When completing the Visiting Questionnaire for the State of California Department of Corrections, it is crucial to carefully adhere to guidelines for a smooth review process. Below is a list of recommended dos and don'ts:
The accuracy and completeness of the information provided are crucial factors in the approval process. This form is not just a formality but a vital piece of documentation that ensures the safety and security of both visitors and inmates. Meticulous attention to detail, honesty, and adherence to the specified instructions facilitate a smoother review process and help avoid unnecessary delays or denials.
When navigating the complexities of the California Department of Corrections (CDC) Visiting Questionnaire form, it's easy for misconceptions to arise. Understanding what the form entails and debunking these misconceptions is vital for those looking to visit their loved ones. Below are some common misunderstandings about the Visiting Questionnaire form:
Clearing up these misconceptions helps streamline the process of visiting an inmate by setting realistic expectations for the applicants. Accurate completion of the form, understanding the rules in place, and patience during the approval process are essential steps toward a successful visitation application.
When filling out the Visiting Questionnaire form provided by the State of California Department of Corrections, there are several key takeaways to be mindful of to ensure the process proceeds smoothly:
Following these guidelines can facilitate a smoother visitation approval process and ensure compliance with the regulations established by the California Department of Corrections.
Fl300 - Instructions within the form emphasize the importance of filing a responsive declaration to avoid court decisions made in one’s absence.
Delaware Prevailing Wage - The inclusion of a penalty clause for non-compliance emphasizes the importance of adhering to the reporting requirements.