Form 106 A PDF Details

Engaging with the criminal justice system in California, either as an inmate or someone on the outside, often involves navigating through various forms and protocols, one of which is the CDCR 106-A Form, Confidential Phone Call Request. This document serves as a means for individuals to request permission to have a confidential telephone conversation with an inmate housed within the California Department of Corrections and Rehabilitation. Such a request mandates the disclosure of personal information, including but not limited to, the names of both the inmate and the requestor, their identification details, and any past convictions of the person making the request. It underscores the importance of transparent and accurate information since any discrepancy or omission can lead to the denial of the confidential call. To ensure privacy and legality, the form also adheres to the Privacy Act of 1974, allowing individuals the option to withhold their Social Security number. This process not only highlights the bureaucratic aspects of correctional system interactions but also underscores the significance of maintaining accurate records and respecting privacy laws. By submitting this form to the institution's Litigation Coordinator's office, individuals embark on a procedural yet essential step towards facilitating communication with inmates, reflecting the broader complexities and considerations of correctional system operations.

QuestionAnswer
Form NameForm 106 A
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescdcr 106 form rev 05 15, cdcr printable formform 106, cdcr 106 a confidential form, cdcr 106 rev 05 17 form

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STATE OF CALIFORNIA

DEPARTMENT OF CORRECTIONS AND REHABILITATION

CONFIDENTIAL PHONE CALL REQUEST

CDCR 106-A (02/08)

READ CAREFULLY. Please PRINT or TYPE. The information requested will be used by officials of the California Department of Corrections and Rehabilitation (CDCR) 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 the confidential phone call. Please mail this form directly to the Litigation Coordinator's office of the institution where the inmate is confined.

1. NAME OF INMATE YOU WANT TO CALL (LAST, FIRST, MIDDLE)

 

 

 

 

INMATE'S CDC NUMBER

 

 

 

 

 

 

 

 

 

2. YOUR NAME (Print your name exactly as indicated on the photo identification you will be using)

 

 

SUFFIX (Jr., Sr., etc.)

OFFICE TELEPHONE NUMBER

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

3. MAIDEN NAME (If applicable)

 

 

HAVE YOU EVER USED ANOTHER NAME? IF SO, PLEASE LIST

FAX NUMBER

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

4. DATE OF BIRTH (Mo/Day/Yr)

AGE

GENDER (Check one)

BIRTHPLACE

(City

 

County

 

State

Country)

MALE

FEMALE

5. ID NUMBER

ID TYPE

 

 

BAR / P. I . NUMBER

BAR STANDING (Check one)

 

 

 

DRIVER'S LICENSE

 

Verified

Unverified

 

 

 

 

 

 

OFFICIAL USE ONLY

ISSUED BY:

(County

State

Country)

6. SOCIAL SECURITY NUMBER (Optional)

EXPIRATION DATE:

 

 

 

 

 

 

 

 

 

 

 

 

 

7. CURRENT MAILING ADDRESS: STREET ADDRESS Apt. # (If Applicable)

CITY

STATE

ZIP CODE

8. HAVE YOU EVER BEEN CONVICTED OF A FELONY?

Yes

No

If YES, complete Item 9A. List all detentions, arrest and convictions. Failure to list all requested information may result in denial of your confidential phone call. Attach additional sheet(s) if necessary.

9. OFFENSE (Check one)

APPROX. DATE

DISPOSITION: (Dismissed, Probation, Jail, Prison)

COUNTY

STATE

*Attorney or Attorney's representative must provide a written request, on official letterhead, indicating the purpose for the confidential phone call.

________________________________________________________

_____________________________________________________________

Signature of Requestor

Date

Signature of CLETS Operator

Date

APPROVED

DISAPPROVED

_______________________________________________

Signature of Litigation Coordinator

Date

OFFICAL USE ONLY – TO BE COMPLETED BY INSTITUTION STAFF

APPROVED

DISAPPROVED

(If DISAPPROVED, the applicant is to be informed in writing of the disapproval.)

REASON FOR DISAPPROVAL:

PRINT NAME

SIGNATURE

TITLE

INSTITUTION

DATE

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This document will need specific details; in order to ensure consistency, please be sure to take heed of the following steps:

1. First of all, once filling out the cdc form106, beging with the page containing next fields:

Completing section 1 of cdcr 106 a confidential form

2. After this array of fields is finished, it is time to insert the essential details in Signature of Requestor Date, Signature of CLETS Operator Date, APPROVED Signature of Litigation, DISAPPROVED, APPROVED, DISAPPROVED, If DISAPPROVED the applicant is to, OFFICAL USE ONLY TO BE COMPLETED, REASON FOR DISAPPROVAL PRINT NAME, SIGNATURE, TITLE, INSTITUTION, and DATE in order to move on to the 3rd step.

How you can fill in cdcr 106 a confidential form part 2

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