Blank Visiting Questionnaire Template

Form Sample

Document Specifications

Steps to Filling Out Visiting Questionnaire

Common mistakes

Documents used along the form

Similar forms

Dos and Don'ts

Misconceptions

Key takeaways

The Visiting Questionnaire form is a document used by the California Department of Corrections to assess whether an individual can visit an inmate. It collects essential information about the visitor and their relationship to the inmate, ensuring compliance with security protocols. To begin the process, please fill out the form by clicking the button below.

Article Structure

The Visiting Questionnaire form, officially designated as CDC 106 by the California Department of Corrections, plays a crucial role in the visitation process for inmates. This form is designed to gather essential information from individuals wishing to visit an inmate, ensuring that the visiting privileges are granted in accordance with institutional regulations and security protocols. Key details required include the inmate's name and CDC number, the visitor's personal information, and their relationship to the inmate. The form also addresses sensitive topics such as prior arrests, current probation or parole status, and any disabilities that may necessitate special accommodations. Additionally, it emphasizes the importance of honesty, as any omissions or inaccuracies can lead to denial of visitation rights. Visitors must also be aware of the legal implications surrounding prison visits, including the potential for searches and restrictions on items that can be brought into the facility. By completing this questionnaire, visitors not only comply with the necessary regulations but also help maintain a secure environment for both inmates and visitors alike.

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			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.
(Check one) YES			O NO
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

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

ADDICT OUTPATIENT STATUS?

ADULT/JUVENILE CORRECTIONAL FACILITY?

IMPOSED PROGRAM? (Check one) Q YES

(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

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:)

INMATE/V1S1TOR NOTIFIED ON (DATE)

BY WHOM

⇩ PDF

Fact Name	Details
Form Title	Visiting Questionnaire CDC 106
State	California
Governing Law	California Penal Code Sections 2772, 2790, 4534, 4570, and others.
Purpose	The form is used to determine approval for visiting an inmate.
Privacy Act Compliance	In accordance with the Privacy Act of 1974, providing a Social Security number is optional.
Submission Instructions	The completed form must be mailed to the visiting office of the institution where the inmate is located.
Visitor Requirements	Visitors under 18 need notarized consent from a parent or guardian.
Disability Accommodations	Visitors with disabilities can request accommodations and must provide verification from a physician.
Notification of Approval	If approved, the inmate will be notified; if disapproved, the visitor will receive a notification by mail.

Filling out the Visiting Questionnaire form is a straightforward process, but accuracy is crucial. After completing the form, you will need to mail it directly to the visiting office of the institution where the inmate is located. Be sure to double-check your answers to ensure everything is clear and correct before sending it off.

Provide Inmate Information: Write the name of the inmate you wish to visit, including their last name, first name, and middle name. Include the inmate's CDC number.
Fill Out Your Personal Information: Enter your name exactly as it appears on your photo identification. Include any suffix (like Jr. or Sr.) and your home telephone number.
Maiden Name and Other Names: If applicable, provide your maiden name and any other names you have used, along with your relationship to the inmate (e.g., spouse, son/daughter).
Date of Birth and Gender: Fill in your date of birth, select your gender, and provide your birthplace (city, county, state, and country).
Identification Information: Indicate your ID number and type (driver's license, state ID, etc.), along with the issuing authority.
Social Security Number: If you choose to provide it, enter your Social Security number and its expiration date.
Current Residence Address: Write your current street address, apartment number (if applicable), city, state, and ZIP code.
Mailing Address: If different from your residence address, provide your mailing address, including city, state, and ZIP code.
Previous Address: List your previous address within the past two years, including any applicable apartment number, city, state, and ZIP code.
Accompanying Minors: If you are bringing minors, list their names, dates of birth, and their relationship to the inmate.
Previous Visits: Indicate if you have visited another inmate in a California prison. If yes, complete the additional information requested.
Criminal History: Answer whether you have ever been detained, arrested, or convicted of a crime. If yes, provide details in the space provided.
Probation or Parole Status: Indicate if you are currently on probation, parole, or under any court-imposed program.
Minor Consent: If you are under 18 and not emancipated, ensure you have notarized consent from a parent or guardian.
Disability Requirements: If you have any special requirements due to a disability, attach a verifying statement from your physician.
Verification of Mailing: Sign and date the form to confirm you have mailed it.

Incomplete Information: Many people forget to fill in all required fields. Missing details, like the inmate's CDC number or your relationship to the inmate, can lead to delays or disapproval.
Incorrect Name Format: The form requests names in a specific format (Last, First, Middle). Not following this format can cause confusion and result in processing issues.
Failure to Use Legal Name: It's crucial to print your name exactly as it appears on your photo identification. Using a nickname or a different name can lead to denial.
Neglecting to Provide Maiden Name: If applicable, omitting your maiden name can hinder the verification process, especially if you've changed your name.
Missing Social Security Number: While providing your Social Security number is optional, failing to include it may complicate your application. If you choose to omit it, ensure all other information is accurate.
Omitting Previous Addresses: Not listing all previous addresses from the past two years can lead to complications. This information is essential for background checks.
Ignoring Criminal History Questions: If you have been detained or convicted of a crime, it’s important to disclose this information. Failing to do so can result in denial of your visit.
Not Providing Additional Documentation: If you have been recently discharged from a facility or are under supervision, failing to attach necessary documents can lead to disapproval.

The Visiting Questionnaire form is an essential document for individuals wishing to visit inmates in California correctional facilities. Alongside this form, several other documents are commonly required to ensure a smooth visiting process. Here are a few of those documents:

Photo Identification: Visitors must provide a valid photo ID, such as a driver’s license or passport. This ID verifies the identity of the visitor and must match the name provided on the Visiting Questionnaire.
Consent Form for Minors: If the visitor is under 18 and not an emancipated minor or the inmate’s legal spouse, a notarized consent form from a parent or legal guardian is necessary. This ensures that minors have appropriate permission to visit.
Verification Statement for Disabilities: Individuals with disabilities may need to submit a statement from a physician. This statement confirms any special requirements for the visit, such as mobility aids or medical devices.
Discharge Paperwork: If the visitor has been recently discharged from a correctional facility, they must provide documentation of their discharge. This paperwork is necessary to confirm eligibility for visiting rights.

These documents help facilitate the visiting process and ensure compliance with institutional regulations. Visitors should prepare these materials in advance to avoid any delays or issues on the day of the visit.

The Visiting Questionnaire form shares similarities with the Visitor Information Form commonly used in various correctional facilities across the United States. Both documents require detailed personal information about the visitor, including identification and relationship to the inmate. This ensures that the facility can maintain accurate records and verify the identity of individuals seeking to visit inmates. Additionally, both forms often inquire about the visitor’s criminal history, which is essential for determining eligibility and ensuring the safety and security of the institution.

Another document that resembles the Visiting Questionnaire is the Inmate Visitation Application. This application serves a similar purpose, collecting information from potential visitors to assess their suitability for visitation. Like the Visiting Questionnaire, it asks for personal details, including names, addresses, and previous visitation history. The primary goal of both documents is to evaluate the visitor's background and relationship with the inmate, facilitating a secure visitation process.

The Family Visitation Request form also parallels the Visiting Questionnaire in its intent and structure. This form is specifically designed for family members who wish to visit incarcerated individuals. It gathers similar information, such as the visitor's relationship to the inmate and any prior visitations. By collecting this data, correctional facilities can better manage visitation schedules and ensure that only approved individuals are allowed access to inmates.

In addition, the Consent for Minor Visitors form bears resemblance to the Visiting Questionnaire. This document is crucial for minors who wish to visit an inmate, requiring parental consent and verification of the adult accompanying the minor. Both forms emphasize the importance of safety and proper identification, ensuring that minors are only allowed to visit under appropriate circumstances.

The Visiting Rules Acknowledgment form is another document that aligns with the Visiting Questionnaire. This form requires visitors to acknowledge their understanding of the rules and regulations governing inmate visitation. Similar to the Visiting Questionnaire, it aims to ensure that visitors are aware of the protocols they must follow to maintain safety within the facility. Both documents contribute to a structured visitation environment by setting clear expectations for visitors.

The Background Check Authorization form also shares similarities with the Visiting Questionnaire. This document is often required by correctional institutions to conduct a thorough background check on potential visitors. Like the Visiting Questionnaire, it collects personal information necessary for evaluating the visitor's criminal history and overall suitability for visitation. Both documents are essential tools for maintaining the security of the institution and its residents.

Additionally, the Emergency Contact Information form is akin to the Visiting Questionnaire in that it collects vital information about the visitor. This form typically requires details about whom to contact in case of an emergency during the visit. While the primary focus of the Visiting Questionnaire is on the visitor's relationship with the inmate, both forms underscore the importance of safety and preparedness within the correctional environment.

Lastly, the Visitor Registration form is similar to the Visiting Questionnaire in its function of gathering essential visitor information. This form is used to register individuals who wish to visit inmates, collecting data such as identification and contact details. Both documents serve to streamline the visitation process, ensuring that correctional facilities have accurate and up-to-date records of all visitors, which is crucial for maintaining security and order.

When filling out the Visiting Questionnaire form, there are important guidelines to follow. Here’s a list of what you should and shouldn't do:

Do print or type your information clearly. This helps avoid any misunderstandings.
Do provide accurate information. Double-check your details before submitting.
Do include your relationship to the inmate. This is necessary for approval.
Do mail the form directly to the correct visiting office. This ensures it reaches the right people.
Don't leave out any sections. Omissions may lead to denial of your visit.
Don't falsify any information. Providing false details can result in serious consequences.

By following these simple guidelines, you can help ensure your application is processed smoothly.

Understanding the Visiting Questionnaire form can be challenging, and there are several misconceptions that can lead to confusion. Here’s a breakdown of ten common misunderstandings regarding this important document:

Misconception 1: Providing a Social Security number is mandatory.

While you are asked to provide your Social Security number, it is optional. Omitting it will not automatically disqualify your application.

Misconception 2: The form can be submitted to any department office.

You must mail the form directly to the visiting office of the institution where the inmate is confined. Submitting it elsewhere will lead to delays.

Misconception 3: Only immediate family members can visit inmates.

While relationships like spouse or child are common, other relationships may also qualify. Be sure to specify your relationship to the inmate on the form.

Misconception 4: Past criminal history automatically disqualifies you from visiting.

Your past does not automatically bar you from visiting. Each application is evaluated on a case-by-case basis.

Misconception 5: Once approved, you can visit anytime without restrictions.

Approval does not guarantee unrestricted access. Each visit may still be subject to rules and regulations of the facility.

Misconception 6: The form is only for adults.

Minors can also visit, but they must have notarized consent from a parent or guardian and be accompanied by an approved adult.

Misconception 7: Visitors with disabilities cannot visit.

Visitors with disabilities can visit, but they must provide documentation of their needs. The institution will strive to accommodate these requirements.

Misconception 8: You can bring gifts for the inmate during your visit.

Bringing gifts is prohibited. This includes food, personal items, or any other gifts, which can lead to legal consequences.

Misconception 9: You will be notified of your application status immediately.

Notifications may take time. If disapproved, you will receive a letter detailing the reasons for the denial.

Misconception 10: The visiting rules are the same for all institutions.

Each correctional institution may have different rules and regulations. Always check the specific guidelines for the facility where the inmate is housed.

By clearing up these misconceptions, you can better navigate the Visiting Questionnaire process and ensure a smoother experience when trying to visit an inmate.

Applicant’s privileges to visit will be reconsidered:

upon receipt of the above requested information

after (DATE:

PRINT NAME

INSTITUTION

When filling out the Visiting Questionnaire form, it is crucial to provide accurate and complete information. Here are some key takeaways to keep in mind:

Accuracy is Essential: Any omissions or false information can lead to the denial of your visiting request. Ensure that all details, especially names and identification numbers, are correct.
Mailing Instructions: Once completed, mail the form directly to the visiting office of the institution where the inmate is confined. Do not send it to any other location.
Social Security Number: Providing your Social Security number is optional. However, be aware that omitting it may affect the processing of your application.
Approval Notification: If your application is approved, the inmate will be notified. Conversely, if it is disapproved, you will receive a notification by mail outlining the reasons for denial.

By following these guidelines, you can help ensure a smoother process for your visit. Take the time to review your form before submission to avoid any unnecessary delays.