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The Visiting Questionnaire form is a crucial document for individuals wishing to visit inmates in California correctional facilities. It serves multiple purposes, primarily to collect essential information that helps officials determine whether a visitor can be approved or disapproved for visitation. The form requests personal details about both the visitor and the inmate, including names, relationships, and identification information. Visitors must provide their current residence and mailing addresses, along with a history of any prior visits to other inmates. Additionally, the form includes questions regarding any past criminal history, probation status, and any accompanying minors. Importantly, it emphasizes the need for accurate and complete information, as any omissions or false statements could lead to denial of visitation rights. Furthermore, the form outlines specific requirements for visitors with disabilities and the legal obligations surrounding prison visits, including the necessity of consent for minors and the conditions under which searches may be conducted upon entering the facility. Understanding these elements is vital for anyone looking to maintain a connection with an inmate, ensuring that the visitation process is smooth and compliant with institutional regulations.

Visiting Questionnaire Example

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 Breakdown

Fact Name Details
Purpose of the Form The Visiting Questionnaire is used by the California Department of Corrections to assess whether a visitor can be approved to visit an inmate.
Privacy Considerations In compliance with the Privacy Act of 1974, providing a Social Security number is optional, but any inaccuracies may lead to denial of visiting privileges.
Submission Instructions Visitors must mail the completed form directly to the visiting office of the institution where the inmate is housed.
Governing Laws The visitation process is governed by various sections of the California Penal Code, including Sections 2772, 2790, and 4570, which outline rules regarding prohibited items and visitor conduct.

Guide to Using Visiting Questionnaire

To successfully complete the Visiting Questionnaire form, follow these detailed steps. Make sure to provide accurate information to avoid any delays in processing. Once the form is filled out, it should be mailed directly to the visiting office of the institution where the inmate is located.

  1. Fill in the inmate's information: Write the inmate's name (last, first, middle) and their CDC number.
  2. Provide your personal details: Enter your name exactly as it appears on your photo ID. Include any suffix (e.g., Jr., Sr.) and your home telephone number.
  3. List your maiden name: If applicable, indicate your maiden name and any other names you have used.
  4. State your relationship: Describe your relationship to the inmate (e.g., spouse, son/daughter).
  5. Enter your date of birth: Specify your birth date, gender, and birthplace (city, county, state, country).
  6. Provide identification details: Select your ID type (e.g., driver’s license, state ID) and enter the ID number and issuing authority.
  7. Social Security number: Provide your Social Security number if you choose to, and indicate the expiration date of your ID.
  8. Current residence: Fill in your street address, apartment number (if applicable), city, state, and ZIP code.
  9. Mailing address: If different from your residence, provide your mailing address, city, state, and ZIP code.
  10. Previous address: List your previous address within the past two years, including apartment number (if applicable), city, state, and ZIP code.
  11. Accompanying minors: If applicable, list the names, dates of birth, and relationships of any minors accompanying you.
  12. Previous inmate visits: Indicate if you have visited other inmates in California prisons and provide their names, CDC numbers, and your relationship to them.
  13. Criminal history: Answer whether you have ever been detained, arrested, or convicted of a crime. If yes, provide details in the designated area.
  14. Probation or parole status: State if you are currently on probation, parole, or under any type of court-imposed program.
  15. Discharge paperwork: If applicable, indicate if you were discharged from an institution in the last twelve months and attach required documents.
  16. Consent for minors: If you are under 18 and not an emancipated minor or the inmate's legal spouse, attach notarized consent from a parent or guardian.
  17. Disability requirements: If you have a disability, include a statement from your physician regarding any special requirements.
  18. Read and understand the regulations: Review the laws related to prison visitation and confirm your understanding by signing the form.
  19. Mail the form: Ensure the completed form is mailed to the appropriate visiting office.

Get Answers on Visiting Questionnaire

What is the purpose of the Visiting Questionnaire form?

The Visiting Questionnaire form is designed to collect essential information about individuals who wish to visit inmates in California correctional facilities. This information helps officials determine whether the visitor meets the criteria for approval. By providing accurate details, you help ensure a smoother process for your visit.

Is providing my Social Security number mandatory?

No, providing your Social Security number is optional. However, it’s important to note that any omissions or inaccuracies on the form can lead to a denial of your visiting request. If you choose not to provide your Social Security number, ensure that all other information is complete and correct to avoid complications.

What should I do if I have a disability and need accommodations?

If you have a disability and require special accommodations, you should attach a statement from your physician to the Visiting Questionnaire. This statement should outline your needs, such as mobility devices or medical equipment. The California Department of Corrections aims to provide reasonable accommodations while maintaining the safety and security of the institution.

How will I know if my application is approved or disapproved?

If your application is approved, the inmate will be notified, and it will be their responsibility to inform you. In case of disapproval, you will receive a notification by mail explaining the reasons for the denial. It’s crucial to wait for this notification before attempting to visit.

What happens if I have a criminal history?

If you have a criminal history, you must disclose it on the form. This includes any detentions, arrests, or convictions. Failure to provide this information can result in denial of your visiting request. The institution will review your history, and depending on the circumstances, you may be advised to reapply after a certain period.

Common mistakes

Filling out the Visiting Questionnaire form accurately is crucial for ensuring a smooth approval process. One common mistake people make is not providing complete information. Omissions can lead to delays or outright disapproval of the visiting request. It is essential to fill out every section of the form, especially those that ask for personal details about the visitor and their relationship to the inmate. Incomplete responses can raise red flags for officials.

Another frequent error is using an incorrect name or identification. Visitors must print their names exactly as they appear on their photo identification. Any discrepancies between the name on the form and the identification can result in denial of the visit. This includes ensuring that maiden names or previous names are accurately listed if applicable. Visitors should double-check this information before submitting the form.

Many individuals also overlook the importance of disclosing all required background information. The questionnaire asks if the visitor has ever been detained, arrested, or convicted of a crime. Failing to provide this information, or not listing all incidents, can lead to disapproval. It is better to be thorough and transparent than to risk denial due to incomplete disclosures.

Lastly, visitors often neglect to attach necessary documentation. For example, if the visitor is under 18, they must include notarized consent from a parent or guardian. Additionally, those with disabilities may need to attach a verifying statement from a physician. Not including these documents can delay the approval process or lead to outright rejection of the application.

Documents used along the form

When preparing to visit an inmate in a California correctional facility, several forms and documents may be required alongside the Visiting Questionnaire form. Understanding these documents can help ensure a smoother visiting process. Below is a list of commonly used forms that may accompany the Visiting Questionnaire.

  • Photo Identification: Visitors must provide a government-issued photo ID, such as a driver's license or passport, to verify their identity. This helps ensure that only authorized individuals are allowed to visit inmates.
  • Notarized Consent Form: If the visitor is under 18 and not an emancipated minor or the inmate’s legal spouse, a notarized consent from a parent or legal guardian is necessary. This form must be presented each time the minor visits.
  • Discharge Papers: For visitors who have been recently discharged from parole or a correctional facility, providing discharge paperwork may be required. This documentation confirms their eligibility to visit.
  • Verification Statement: Individuals with disabilities may need to attach a statement from their physician confirming their condition. This ensures that the facility can provide necessary accommodations during the visit.
  • Criminal History Disclosure: If applicable, visitors may need to disclose any past criminal history. This information is essential for security evaluations and can impact visiting privileges.
  • Visitor Application Form: In some cases, a separate application form may be required. This form collects additional information about the visitor and is used to assess eligibility for visitation.

Being prepared with the necessary documentation can help facilitate the approval process for visiting an inmate. Ensure that all forms are completed accurately and submitted as required to avoid any delays. If there are any questions or concerns, contacting the institution directly can provide clarity and assistance.

Similar forms

The Visiting Questionnaire form serves a crucial role in the process of inmate visitation within California's correctional facilities. Several other documents share similarities with this form in terms of purpose, information collection, and procedural requirements. Below are eight documents that resemble the Visiting Questionnaire, along with a brief explanation of their similarities.

  • Visitor Application Form: Like the Visiting Questionnaire, this form collects personal information about the visitor, including identification details and relationship to the inmate, to assess eligibility for visitation.
  • Inmate Release Form: This document often requires information about the inmate's background and the visitor's relationship, similar to how the Visiting Questionnaire verifies connections between visitors and inmates.
  • Background Check Authorization Form: This form requests personal information and consent for background checks, paralleling the Visiting Questionnaire's need for disclosure of criminal history and other personal details.
  • Emergency Contact Form: This document gathers contact information and personal details about individuals who can be reached in case of emergencies, akin to the information collected in the Visiting Questionnaire.
  • Visitor Rules Acknowledgment Form: This form requires visitors to acknowledge understanding of the rules and regulations governing visits, similar to the agreement section in the Visiting Questionnaire.
  • Minor Visitor Consent Form: This document is used when minors visit inmates, requiring parental consent, much like the Visiting Questionnaire’s provisions for minors and their visiting requirements.
  • Health Screening Form: This form collects health-related information from visitors to ensure safety during visits, paralleling the Visiting Questionnaire's attention to any special requirements or disabilities.
  • Identification Verification Form: This document confirms the identity of the visitor, requesting similar identification information as the Visiting Questionnaire to ensure that only approved individuals can visit inmates.

Dos and Don'ts

When filling out the Visiting Questionnaire form, there are several important things to keep in mind. Below is a list of what you should and shouldn't do.

  • Do read the instructions carefully before starting.
  • Do print or type your answers clearly.
  • Do provide accurate information about yourself and the inmate.
  • Do include your Social Security number if you choose to provide it.
  • Don't leave any required fields blank.
  • Don't falsify any information, as this may lead to denial of visiting.
  • Don't forget to mail the form directly to the visiting office of the institution.

Misconceptions

Understanding the Visiting Questionnaire form is essential for anyone looking to visit an inmate in a California correctional facility. However, several misconceptions about this form can lead to confusion. Here are five common misconceptions and clarifications regarding the Visiting Questionnaire:

  • Misconception 1: The Social Security number is mandatory.
  • While the form asks for your Social Security number, it is optional. The Privacy Act of 1974 allows you to choose whether to provide this information. However, not including it may affect the processing of your application.

  • Misconception 2: Only immediate family members can visit inmates.
  • While immediate family members are typically prioritized, the form allows for other relationships to be disclosed. Friends or extended family members can also apply to visit, provided they fill out the questionnaire accurately.

  • Misconception 3: Past criminal history automatically disqualifies a visitor.
  • Having a criminal history does not automatically mean you will be denied visitation. The institution reviews each case individually, considering the nature of the offenses and how they relate to institutional security.

  • Misconception 4: Submitting the form guarantees approval.
  • Submitting the Visiting Questionnaire does not guarantee that you will be approved to visit. The institution will evaluate the information provided and determine whether to approve or deny the application based on their criteria.

  • Misconception 5: Visitors do not need to follow any rules once approved.
  • Approval to visit does not exempt you from following all rules and regulations set by the institution. Visitors are subject to searches and must adhere to all guidelines to maintain their visiting privileges.

Key takeaways

When filling out and using the Visiting Questionnaire form, keep the following key takeaways in mind:

  • Print or Type: Ensure all information is clearly printed or typed to avoid misunderstandings.
  • Privacy Matters: Your Social Security number is optional, but any inaccuracies may lead to a denial of your visiting request.
  • Direct Submission: Mail the completed form directly to the visiting office of the institution where the inmate is housed.
  • Accurate Information: Provide accurate details about your relationship to the inmate and any previous visits to other inmates.
  • Criminal History: Be honest about any past detentions or convictions. Omitting this information can result in disapproval.
  • Minor Visitors: If you are under 18, you need notarized consent from a parent or guardian to visit.
  • Disability Accommodations: Attach a statement from your physician if you have special requirements due to a disability.
  • Search Policies: Be prepared for searches upon entering the facility. Refusing a search may lead to denial of your visit.
  • Notification of Approval: If approved, the inmate will be notified, and it’s their responsibility to inform you.
  • Follow the Rules: Familiarize yourself with all Federal, State, and CDC regulations to ensure a smooth visiting experience.