Visiting Questionnaire PDF Template

Visiting Questionnaire PDF Template

The Visiting Questionnaire form is an essential document used by the California Department of Corrections to assess potential visitors for inmates. This form collects vital information that helps determine whether a visitor can be approved or disapproved for visitation rights. Completing this form accurately is crucial, as any errors or omissions may lead to denial of visiting privileges.

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Article Guide

The Visiting Questionnaire form, officially known as CDC 106, serves a crucial role in facilitating visits to inmates within California's correctional facilities. This form is essential for anyone wishing to visit an inmate, as it collects vital information that the California Department of Corrections (CDC) uses to determine eligibility for visitation. Key aspects of the form include personal identification details of the visitor, such as name, address, and contact information, alongside the inmate's name and CDC number. Additionally, the form requests information about previous visits to other inmates, any criminal history, and current legal statuses like probation or parole. It's important to note that providing a Social Security number is optional, but any inaccuracies or omissions may lead to a denial of the visit. The completed questionnaire must be mailed directly to the institution's visiting office, ensuring that the information is processed efficiently. Furthermore, the form outlines specific requirements for minors and visitors with disabilities, as well as the legal implications of visiting, including the necessity to submit to searches upon entering the facility. Understanding these components is vital for a smooth visitation process, allowing families and friends to maintain connections with their loved ones in a correctional setting.

Visiting Questionnaire Preview

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

File Properties

Fact Name Description
Form Title Visiting Questionnaire, CDC 106 (Rev. 01/03)
Governing Authority California Department of Corrections (CDC)
Purpose The form is used to determine if a visitor's application to visit an inmate will be approved or denied.
Privacy Act Compliance In accordance with the Privacy Act of 1974, providing a Social Security number is optional.
Mailing Instructions The completed form must be mailed directly to the visiting office of the institution where the inmate is confined.
Visitor's Age Requirement Visitors under 18 must have notarized consent from a parent or legal guardian.
Special Accommodations Visitors with disabilities may need to attach a verifying statement from their physician for accommodations.
Legal Compliance Visitors are subject to search upon entering the correctional facility, and refusal may result in denial of visiting.
Notification of Approval If approved, the inmate will be notified. Disapprovals will be communicated by mail.

Instructions on Utilizing Visiting Questionnaire

After completing the Visiting Questionnaire form, it is essential to mail it directly to the visiting office of the institution where the inmate is confined. Ensure that all information is accurate and complete to avoid any delays or disapproval of your visit.

  1. Fill in the inmate's name: Write the last name, first name, and middle name of the inmate you wish to visit, along with their 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. Include maiden name: If applicable, write your maiden name and any other names you have used, along with your relationship to the inmate.
  4. Enter your date of birth: Fill in your birth date, gender, and birthplace (city, county, state, and country).
  5. List your ID information: Provide your ID number and select the type of ID you are using (e.g., driver's license, state ID, military ID). Include the issuing authority.
  6. Fill in your Social Security number: This is optional, but if you provide it, also include the expiration date.
  7. Current residence address: Write 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, city, state, and ZIP code.
  9. Previous address: List your previous address within the past two years, including apartment number (if applicable), city, state, and ZIP code.
  10. Accompanying minors: If you are bringing minors, list their names, dates of birth, and relationship to the inmate.
  11. Previous inmate visits: Indicate whether you have visited another inmate in a California prison. If yes, complete the additional information requested.
  12. Criminal history: Answer whether you have ever been detained, arrested, or convicted of a crime. If yes, provide details.
  13. Probation or parole status: Indicate if you are currently on probation, parole, or under any type of court-imposed program. Provide details if applicable.
  14. Minor consent: If you are under 18 and not an emancipated minor, ensure you have notarized consent from a parent or guardian.
  15. Disability requirements: If you have any special needs due to a disability, attach a verifying statement from your physician.
  16. Read the regulations: Familiarize yourself with the laws related to prison visitation, including search policies and restrictions.
  17. Sign the form: Both you and the inmate must sign and date the form where indicated.

Important Facts about Visiting Questionnaire

What is the purpose of the Visiting Questionnaire form?

The Visiting Questionnaire form is designed to collect essential information from individuals wishing to visit an inmate in a California correctional facility. This information helps officials at the California Department of Corrections determine whether the visit can be approved. The form ensures that all necessary details are documented and that the visiting process adheres to safety and security protocols.

Is it mandatory to provide my Social Security number on the form?

Providing your Social Security number on the Visiting Questionnaire is optional. According to the Privacy Act of 1974, you are not required to disclose this information. However, it is important to note that any omission or falsification of information may result in the denial of your visiting application. Therefore, it is advisable to provide accurate and complete information to avoid complications.

What happens if my Visiting Questionnaire is disapproved?

If your Visiting Questionnaire is disapproved, you will receive a notification by mail from the institution. The letter will outline the reasons for the disapproval. It is crucial to understand that you will not be permitted to visit the inmate until your application has been approved. You may reapply after addressing the issues that led to the disapproval.

What should I do if I have a disability and need assistance during my visit?

If you have a disability and require special accommodations, you should attach a statement from your physician verifying your needs. This may include assistance with mobility devices or medical equipment. The California Department of Corrections aims to provide reasonable accommodations while ensuring the safety and security of the institution. It is recommended to contact the institution beforehand to discuss any specific requirements you may have.

Can minors visit an inmate, and what are the requirements?

Minors under the age of 18 can visit an inmate, but they must meet certain conditions. If the minor is not an emancipated minor or the legal spouse of the inmate, written notarized consent from a parent or legal guardian is required. Additionally, the minor must be accompanied by a responsible adult who is also approved to visit. This consent must be presented each time the minor visits unless prior approval has been granted by the Warden for unchaperoned visits.

What should I do if I have previously visited another inmate?

If you have visited another inmate in a California prison, you must indicate this on the Visiting Questionnaire. You will need to provide details about your previous visits, including the names and CDC numbers of the inmates, as well as your relationship to them. This information helps the institution assess your visiting history and may influence the approval of your current application.

Common mistakes

Completing the Visiting Questionnaire form for the California Department of Corrections requires careful attention to detail. Many individuals make common mistakes that can lead to delays or outright denials of their visiting requests. One prevalent error is failing to provide accurate information regarding the inmate’s name and CDC number. This information is critical for processing the application. Any discrepancies can result in confusion, causing the form to be rejected.

Another frequent mistake involves the omission of required personal details. Visitors often forget to include their full name as it appears on their photo identification. This inconsistency can raise red flags during verification. Additionally, some individuals neglect to list their maiden name or any other names they have used. Such omissions can complicate background checks and may lead to disapproval.

Many applicants also overlook the importance of their current residence address. Providing an incomplete or incorrect address can hinder communication between the institution and the visitor. Furthermore, if a mailing address differs from the residence address, this must be clearly indicated. Failure to do so can result in significant delays in processing the application.

Another common error is not fully disclosing past criminal history. Applicants sometimes mistakenly believe that minor offenses do not need to be reported. However, all arrests, detentions, and convictions must be listed. Omitting this information can lead to automatic disqualification. It is essential to be thorough and transparent in this section to avoid complications.

Lastly, individuals often fail to attach necessary documentation, especially when it comes to special requirements related to disabilities. If a visitor requires accommodations, a verifying statement from a physician must be included. Not providing this documentation can lead to the application being deemed incomplete. Ensuring that all required attachments are included is vital for a smooth approval process.

Documents used along the form

The Visiting Questionnaire form is an essential document for individuals seeking to visit inmates in California's correctional facilities. However, several other forms and documents often accompany this questionnaire to ensure compliance with regulations and facilitate the visiting process. Below is a list of these documents, each serving a specific purpose in the context of prison visitation.

  • Consent Form for Minors: This document is required when a visitor is under 18 years of age and not an emancipated minor or the legal spouse of the inmate. It must be notarized and signed by a parent or legal guardian, granting permission for the minor to visit the inmate.
  • Proof of Relationship Documentation: Visitors may need to provide evidence of their relationship to the inmate, such as birth certificates, marriage licenses, or other legal documents. This helps verify the claims made in the Visiting Questionnaire.
  • Discharge Papers: If a visitor has recently been released from a correctional facility or completed parole, they must submit discharge paperwork. This documentation is crucial for verifying their eligibility to visit.
  • Verification of Disability Accommodations: For visitors with disabilities, a statement from a physician may be required to confirm any special needs or requirements during the visit. This ensures that appropriate accommodations can be made.
  • Criminal History Disclosure Form: Some facilities may require visitors to disclose their criminal history, including any arrests or convictions. This form helps the institution assess the visitor's eligibility based on their past actions.
  • Visitor Identification: Visitors must present a valid form of identification, such as a driver’s license or state ID, at the time of the visit. This is necessary for verifying the identity of the visitor against the information provided in the Visiting Questionnaire.

Understanding the various forms and documents needed alongside the Visiting Questionnaire can streamline the application process and enhance the chances of a successful visit. Ensuring that all required paperwork is completed and submitted accurately is vital for compliance with institutional regulations.

Similar forms

The Visiting Questionnaire form is designed to collect essential information for individuals wishing to visit inmates. Several other documents serve similar purposes in various contexts. Here’s a list of four documents that are comparable to the Visiting Questionnaire:

  • Visitor Application Form: This form is often used in different correctional facilities to gather personal details about visitors. Like the Visiting Questionnaire, it includes sections for identification, relationship to the inmate, and any criminal history, ensuring that the facility can assess the visitor's eligibility.
  • Background Check Consent Form: Visitors may be required to complete this form to authorize a background check. Similar to the Visiting Questionnaire, it requests personal information and may inquire about past criminal activity, helping institutions determine the safety of allowing a visit.
  • Inmate Release Notification Form: This document informs relevant parties about an inmate's release. It is similar in that it requires information about the inmate and the relationship of the notifier, ensuring that proper procedures are followed upon the inmate’s release.
  • Minor Visitor Consent Form: This form is specifically for minors who wish to visit inmates. Like the Visiting Questionnaire, it requires parental consent and details about the minor's relationship to the inmate, ensuring compliance with visitation regulations for younger visitors.

Dos and Don'ts

When filling out the Visiting Questionnaire form for the California Department of Corrections, it’s important to ensure that the process goes smoothly. Here are some key do's and don'ts to keep in mind:

  • Do print or type your answers clearly. This helps prevent misunderstandings and ensures your application is processed quickly.
  • Do provide accurate and complete information. Omissions or inaccuracies may lead to denial of your visiting request.
  • Do include your relationship to the inmate. This information is crucial for approval.
  • Do ensure that any accompanying minors have the required notarized consent if applicable.
  • Don't leave out your Social Security number if you choose to include it. Remember, it’s optional, but if provided, it must be accurate.
  • Don't forget to sign and date the form before mailing it. An unsigned form can delay your application.

By following these guidelines, you can help facilitate a smoother application process and increase the chances of your visiting request being approved.

Misconceptions

Misconceptions about the Visiting Questionnaire form can lead to confusion and frustration. Here are eight common misunderstandings, along with explanations to clarify them:

  • It’s mandatory to provide a Social Security number. In fact, providing your Social Security number is optional. While it may help with identification, omitting it will not automatically disqualify you from visiting.
  • Only family members can fill out the form. While the form is primarily for family members, friends and other approved visitors can also submit it to visit an inmate.
  • Submitting the form guarantees a visit. Approval is not guaranteed. The information provided will be reviewed, and the institution reserves the right to deny visits based on various factors.
  • Previous criminal history automatically disqualifies you. Not necessarily. While your criminal background will be considered, each application is evaluated on a case-by-case basis.
  • All information is kept private and confidential. While the form is subject to privacy regulations, some information may still be shared with relevant authorities as needed.
  • You can visit immediately after submitting the form. After submission, you must wait for approval. The institution will notify you of your status, and you cannot visit until you receive confirmation.
  • Minors can visit without any special permissions. Minors under 18 must have written consent from a parent or guardian and be accompanied by an approved adult.
  • Visitors are not subject to searches. All visitors are subject to searches of their person, vehicle, and property before entering the facility. Refusal to submit to a search will result in denial of entry.

Understanding these points can help ensure a smoother process when applying to visit an inmate. Always read the form carefully and provide accurate information to avoid delays or disapprovals.

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 some key takeaways to keep in mind:

  • Accuracy is Essential: Ensure that all information provided is accurate and complete. Any omissions or inaccuracies may lead to denial of your visiting request.
  • Social Security Number: Providing your Social Security number is optional. However, if you choose to include it, ensure it is correct, as it may be used for background checks.
  • Mailing Instructions: Send the completed form directly to the visiting office of the institution where the inmate is housed. This ensures that your application is processed in a timely manner.
  • Minors Require Consent: If you are under 18 years old, you must have a notarized consent from a parent or legal guardian to visit. Additionally, you need to be accompanied by an approved adult.
  • Disability Accommodations: If you have special needs due to a disability, attach a statement from your physician. The institution strives to provide reasonable accommodations for visitors with disabilities.
  • Follow-Up on Approval: If your application is approved, the inmate will be notified. If disapproved, you will receive a notification by mail explaining the reasons for denial.

Understanding these key points can help facilitate a smoother visiting experience. Always reach out to the institution if you have any questions or concerns regarding the visiting process.