CDCR 106-A Form PDF Details

Understanding the intricacies of the CDCR 106-A form is crucial for those seeking a confidential phone call with an inmate housed within the California Department of Corrections and Rehabilitation (CDCDR). This form is a key document used by CDCDR officials to evaluate whether a request for such a confidential communication will be granted. It's important that all information provided on the form is accurate and complete, encompassing everything from personal identification details to any past felony convictions the requester may have. The form also respects the Privacy Act of 1974 regarding the optional provision of Social Security numbers, while emphasizing the importance of honesty in the application process. Failure to accurately disclose information or the falsification of details can lead to the denial of the request. Additionally, the form requires a written statement from an attorney or their representative if the request is being made for legal reasons, ensuring that all communication maintains its intended confidentiality. This comprehensive approach underscores the CDCDR's commitment to maintaining security and privacy, while also accommodating the rights of inmates to communicate with the outside world under certain conditions. By mailing the completed form to the Litigation Coordinator's office at the inmate’s facility, applicants initiate a process that balances legal rights with institutional regulations.

QuestionAnswer
Form NameCDCR 106-A Form
Form Length1 pages
Fillable?Yes
Fillable fields53
Avg. time to fill out10 min 55 sec
Other namesSUFFIX, CDC, CLETS, APPROX

Form Preview Example

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