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The form explains that institution officials may contact law-enforcement or crime-information agencies for suitability and adverse-effects review under federal authority. It instructs the applicant to complete the questionnaire and return it with the authorization to release information, including required personal, relationship, supervision, correspondence, and conviction details, with signature authorization.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/bp-a0629-visitor-information-release-form/305970/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/bp-a0629-visitor-information-release-form/305970.png","ImageObject",442,249,{"name":88,"@type":89},"Dozel","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-09","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",6,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What is the purpose of this visitor information questionnaire and release form?","Question",{"text":109,"@type":110},"It is used to determine whether a proposed visitor is acceptable and to assess whether placing the person on the visiting list could create management problems or other adverse effects.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"Is the visitor required to provide the requested information?",{"text":114,"@type":110},"No, supplying the information is not required. 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DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS  \n\n|  |  |  |\n| --- | --- | --- |\n|  |  |  |\n| Addressee | Institution | Date |\n|  | Re : ( Inmate’s Name and Register No. ) |  |\n\nDear   :  \nI am requesting that you be included among my approved visitors. In order to establish your suitability asa visitor, it may be necessary for institution officials to send an inquiry to an appropriate law enforcement or crime information agency to ascertain whether or not placing you on my visiting list would present a management problem for the institution, or have other possible adverse effects. The information obtained will be used to determine your acceptability as a visitor. The Bureau of Prisons’ authority to request background information on proposed visitors is contained in Title 18 U .S .C. § 4042.  \nIn order for you to be considered for the visiting privilege with me, it will be necessary for you to fill out the questionnaire and release form below and return it to the following address: (Institution address) .  \nYou are not required to supply the information requested. However, if you do not furnish the information, the processing of your request will be suspended, and you will receive no further consideration. If you furnish only part of the information required, the processing of your request may be significantly delayed. If the information withheld is found to be essential to the processing of your request, you will be informed, and your request will receive no further consideration unless you supply the missing information. Although no penalties are authorized if you do not supply the information requested, failure to supply such information could result in your not being considered for admittance as a visitor. The criminal penalty for making false statements is a fine of not more than $250,000 or imprisonment for not more than five years or both (See 18 U .S .C . § 1001) .  \nSincerely,  \n\n| 1 . Legal Name |  | 2 . Date of Birth |  | 3 . Address (Including Zip Code) |\n| --- | --- | --- | --- | --- |\n| 4 . Telephone Number\u003Cbr>(Including Area Code) | 5 . Race and Sex of Visitor |  |  |  |\n| 6 . Are you a U .S . Citizen?   Yes   No | 6a. If yes, provide Social Security No :   6b. If no, provide Alien Registration No:   |  |  |  |\n|  | 6c. Provide Passport No :   |  |  |  |\n| 7 . Relationship to above-named inmate |  |  | 8 . Do you desire to visit him/her?\u003Cbr>  Yes   No |  |\n\n9. Did you know this person prior to his/her current incarceration?   Yes   No  \n10 . If the answer to \\#9 is yes, indicate the length of time you have known this person and where the relationship developed.  \n11 . Have you ever been convicted of a crime? If so, state the number, date, place, and nature of the conviction/s:  \n\n| 12 . Are you currently on probation, parole, or any other type of supervision? If so, state the name of your supervising probation/parole officer and the address and telephone no. where he/she can be contacted: |\n| --- |\n| 13 . Do you correspond or visit with other inmates? If so, indicate the individual(s) and their location (s): |\n| 14 . Driver’s License No . and State of Issuance |\n\nAUTHORIZATION TO RELEASE INFORMATION  \nI hereby authorize release to the Warden of:   any record of criminal offenses for which I  \n(Institution, Location)  \nhave been arrested and convicted, and any information related to those convictions.  \nSignature for Authorization to Release Information (Sign and Print Name)Parent or Guardia  \n(If applicant is under 18 years of age, signature of parent or guardian indicates consent of minor to visit inmate) .  \nIf additional space is required, you may use the back of this form.  \nTo be filed in Inmate Central File, FOI Section 2  \nPDF Prescribed by P5267 Replaces BP-A629 of Sep 00  \nFILE IN SECTION 3 UNLESS APPROPRIATE FOR PRIVACY FOLDER SECTION 3  \nBP-A0629 INFORMACIÓN DE VISITANTE CDFRM  \n\"13  \nDEPARTAMENTO DE JUSTICIA DE EE .UU . AGENCIA FEDERAL DE PRI SION","cbCaipnfJyHJfn86","https://ap.wps.com/l/cbCaipnfJyHJfn86","pdf",355440,"English","# Addressee, Institution, Date\n# Visitor Suitability Request\n# Questionnaire Fields (Visitor Details)\n## Legal Name, DOB, Address\n## Telephone, Race/Sex, Citizenship and IDs\n## Relationship and Visit Intent\n## Prior Knowledge and Relationship Details\n## Convictions, Probation/Parole, Correspondence\n## Driver’s License\n# Authorization to Release Information","[{\"question\":\"What is the purpose of this visitor information questionnaire and release form?\",\"answer\":\"It is used to determine whether a proposed visitor is acceptable and to assess whether placing the person on the visiting list could create management problems or other adverse effects.\"},{\"question\":\"Is the visitor required to provide the requested information?\",\"answer\":\"No, supplying the information is not required. However, if the information is not furnished, processing of the request is suspended and no further consideration is provided; partial information may delay processing.\"},{\"question\":\"What happens if the visitor provides false statements?\",\"answer\":\"The form states that making false statements can result in a criminal penalty of a fine up to $250,000 and/or imprisonment for up to five years (citing 18 U.S.C. § 1001).\"}]","BP-A0629 Visitor Information - Release Form | PDF",1789831616]