Bobby Brown Fcc Complaint 2012
Download original document:

Document text

Document text
This text is machine-read, and may contain errors. Check the original document to verify accuracy.
Received &Inspected
SEP -42012
JEAN ROSS, ESQ
32 Markham Road
Princeton, New Jersey 08540
609-924-6508 phone and fax
jeanross55@aol.com
FCC Mail Room
August 232012
Julie Veach, Chief
Federal Communications Commission
Wireless Competition Bureau
Office of the Secretary
445 12th Street SW
Room TW-B204
Washington, DC 20554
Re~18jRt of Bnbbl' ~
ef. Docket # 96-128
Dear Chief Veach,I
Per your suggestion.
Please see the enclosed Fax.
Thank you again for your attention to this matter.
C dially,)
-
c'~ f~
ean Ross, Esq.
Encl.
Email Communication
Complaint IRequest for Investigation
and Exhibits
.,
.
FAX TRANSMISSION
JEAN ROSS, Esq.
32 Markham Road
Princeton, New Jersey 08540
office phone = 609-924-6508 cell phone = 609-802-4777
jeanross55@aol.com
fax = 609-924-6508
To:
Julie Veach, Chief
Wireline Competition Bureau
Fax#:
202-418-2825
From:
Jean Ross, Esq.
Subject:
Request for Investigation of Unreasonable and Discriminatory Phone Rates (in
New Jersey) by Bobby Brown
Docket No. 96-128
OR.
f fI \
Date:
August 23,2012
Pages:
22 pages
I
Dear Chief Veach,
Please find "enclosed" the Complaint submitted by Bobby Brown at NJ State Prison on January
10,2012.
I will send you 2 hard copies of the Complaint and exhibits tomorrow, so you can send me a
stamped copy, as Mr. Brown requested. It's safer to send to me, so I can copy it before sending it
in to the prison, whose mail system is not always reliable.
Mr. Brown tells me that he sent a check for $25 with his original application and has a copy of
the check. I hope that there is no filing fee, but if there is, please let me know and I will take care
of it. If you do not have a record of Mr. Brown's $25 check, I will ask him to send me a copy to
forward to you.
Thank you for your attention to this matter.
Finally, I know that there are many people in New Jersey who are very concerned about the
prison phone system. We will be following up the State's negotiations with GTL about the
contract that must be renegotiated by March 3, 2013.
Weare also very interested in the status of proceeding #96-128. Can you give me any
information about that proceeding?
YOUagai
Je
h
_
L7'1
oss, Esq.
(/
Ie's Organization for Progress.
"
TRANSMISSION VERIFICATION REPORT
TIME
NAME
FAX
TEL
SER.#
DATE,TIME
FAX NO./NAME
DURATION
PAGE{S)
RESULT
MODE
138/23 19:33
121324182825
1313:133:136
22
OK
STANDARD
ECM
138/23/21312 19:36
JROSS
613992465138
613992465138
HaN446899
Page 1 of2
Subj:
Date:
From:
To:
CC:
RE: Request for Investigatioin of Global Tel Link
7/19/20129:42:38 A.M. Eastern Daylight Time
JulieVeach@fcc.gov
JeanRoss55@aol.com
Travis.Litman@fcc.gov
Thank you. If you can also email it to me atjulie.veach@fcc.gov or fax it to my attention at (202)
418-2825, I'll have it in hand while the official copy comes up from the mail room.
Regards,
Julie Veach
---_._---,_._----From: JeanRossSS@aol.com [mailto:JeanRossSS@aol.com]
Sent: Thursday, July 19, 2012 8:26 AM
To: Julie Veach
Cc: jeanrossSS@aol.com
Subject: Re: Request for Investigatioin of Global Tel Link
Dear Secretary Veach,
Thank you for responding to my inquiry. I am away from my office this week, but will send you Mr. Brown's
complaint when I return.
Jean Ross, Esq.
In a message dated 7/18/201210:15:41 P.M. Eastern Daylight Time, JulieVeach@fcc.govwrites:
Dear Ms. Ross,
Thank you for your email. After conducting a search within the Wireline Competition Bureau and also
in the Enforcement Bureau, we have been unable to locate any record of Mr. Brown's complaint. If you
or Mr. Brown have a copy of Mr. Brown's complaint and would like to forward it to my attention, it would
be greatly appreciated. In any event, for future reference, I am attaching a copy of the Commission's
guide on filing formal or informal complaints with the FCC.
As you may also know, the FCC has an open proceeding in connection with inmate payphone rates.
Any member of the public may participate in that proceeding. If Mr. Brown would like to participate, he
can send his comments in a letter to the FCC. The letter should reference docket number 96-128 on
the first page and be addressed to:
Marlene H. Dortch, Secretary
Federal Communications Commission
Office of the Secretary
445 12th Street, SW
Room TW-B204
Washington, DC 20554.
Alternatively, comments in the inmate payphone proceeding can be filed electronically by selecting
docket number 96-128 "Pay Telephone Compensation Issues including Inmate Pay Telephones" at the
following web address: http://apps.fcc.gov/ecfs//hotdockeUlist.
I hope this information is helpful.
Regards,
Julie Veach
Sunday, July 22, 2012 AOL: JeanRoss55
Received &Inspected
SEP -42012
Bobby Brown
#249446/#722093b
New Jersey State Prison
P.O. Box 861
Trenton, New Jersey 08625
Requestor Confined
FCC Mail Room
Date: January 10, 2012
BEFOR~ THE
FEDERAL COMMUNICATIONS COMMISSION
WASHINGTON, DC 20554
In re:
Application of Pobby Brown
As An Infor11lal R.equest For An
Investigation of Unreasonable
and Discriminatory Rates And
Practices
File No. _________________
Docket No.
--------------
To: Federal Communication Commission
Wireline Competition Bureau
Chief, Ms. Sharon Gillett
445,12th St., S.W. 5th Floor
Washington, DC 20554
To: Global Tel* Lipk
2609 Cameron Street
Mobile, Alabama 36607
Dear Sir or Madam:
Please
fir:Ld
here
enclosed
for
filing,
an
informal
I
complaint with the necessary' supporting documents.
I request
that a stamped UFILED" copy be returned to me at the above
address of complainant.
As
this
matter
is
"informal"
I
only
request
that
whatever amendments needed or made by the appropriate agency
be made according to the filing.
--'-" ,_., -
-"
-,---- -----------
- - - - ._-
in this matter!
Pro Se
1
- - - - . - . - _.,'--------
SUMMARY OF THE FIIJNG
The
herein
Complainant
Bobby
Brown moves
before
the
Federal Communication Commission via, Presiding Officer, Ms.
Sharon Gillett pursuant to 47 C.F.R.
1.209 and submit this
summary pursuant to 47 C.F.R. 1.49(c).
This
complaint
unreasonable,
Tel Link.
have
is
informal,
and
based
on
unjust,
and discriminatory rates and usage by Global
This includes limitation on calls for those who
families
exception,
of
outside
a
few
of
the
neighboring
United
States
with
the
cell
phone
ban
islands,
connection from family usage.
The
complainant request an investigation if necessary
concerning
the
company,
and whether
there
is
a
need
for
comparison with other states including those who have banned
GTL for the same purpose.
As. the complainant,
I
submit that there is legitimate
alternative means by which this company is able to operate
and the state without gauging prices from families.
Therefore, there is a request to investigate the matters
if the request is legitimate by complainant.
2
Bobby Brown
#249446/#722093b
New Jersey State Prison
P.o. Box 861
Trenton, New Jersey 08625
Requestor Confined
Date: January 10, 2012
BEFORE THE
FEDERAL COMMUNICATIONS COMMISSION
WASHINGTON, DC 20554
In re:
Application of Bobby Brown
As An Informal Request For An
Investigation of Unreasonable
and Discriminatory Rates And
Practices
File No.
-------
Docket No. - - - - - -
To: Federal Communication Commission
Wireline Competition Bureau
Chief, Ms. Sharon Gillett
445 12th St., S.W. 5th Floor
Washington, DC 20554
To: Global Tel* Link
2609 Cameron Street
Mobile, Alabama 36607
INFORMAL REQUEST FOR AN
INVESTIGATION OF UNREASONABLE AND DISCRIMINATORY RATES
AND PRACTICES
Pursuant to 47 USCA §1.1410(a), and 47 CFR §§ 1.41 the
Requestor Bobby Brown in the above captioned matter, pro se,
informally
services,
request
an
investigation
for
discriminatory
unjust and unreasonable rates by Global Tel* Link
based on the following facts:
1.
I
am an inmate confined here
in New Jersey State
Prison, P.o. Box 861, Trenton, New Jersey 08625.
3
FACTS AND INTEREST
.2.
Tel *
Global
Department
of
Link has
Corrections
a
contract
to provide
with New
telephone
Jersey
service
inmates in its correctional facilities at the rate of
to
.33
cents a minute and .33 cents for each additional minute for
local (intrastate and interstate) telephone calls.
3.
Inmates are allowed to make collect calls,
and the
pre-paid calls which are charged against the inmates trust
account are the same rate of .33 cents per minutes.
4.
phones,
Inmates
are
prohibited
from making
calls
to
cell
and no service is provided for inmates who need to
make international phone calls with the exception of Jamaica,
Virgin Islands and Puerto Rico.
5. The contract does not provide international calling
service
to
other
inmates.
The
New
Jersey
Department
Corrections provides an alternate method for
of
international
calling services through the Social Workers Department and
costing
approximately
averaging at $4.40
$13.04
for
the
first
minute,
and
for each additional minute for Germany
f
and the rates will vary depending on the country.
6. Under the contract, an inmate may not make more than
$200.00 worth of collect calls during ariy month.
inmate
has
accumulated
collect
calls
totaling
Once the
$200.00,
a
block is placed on the collect calls without the inmate or
person(s)
accepting
the
calls
consent
or
any
number
the
inmate wish to call has exceeded $200.00. The result of the
4
block
in
turns
gives
a
recording
authorized for collect calls."
"this
There
number
is
not
is no notice to the
general population inmates in New Jersey State Prison.
7.
To
remove
the
block,
the
person
receiving
the
collect calls must immediately go to his/her Phone Company,
and request that the block be removed, and then, place money
on the
account
practically paying
for
time by the minute
plus, applicable taxes and fees.
8.
fami:
There
is
a
common practice by phone
companies
of
members after an IPIN number has been updated with new
phone numbers to place a block on the telephone approved for
~alling
without consent of the family .
.itionally, calls made to families and friends who
have operator providers like AT&T et als., can not always get
through because there is an un-approved block on th2: phone
which does not recognize the other carrier's specific access
code.
This in turns gives a recording that "this number is
not authorized for collect calls" as stated in (paragraph 6) .
10. The rate of .33 cents per minute under the_ mtract
far
exceeds
the
actual
cost
reasonable profit for GTL.
of
telephone
services
and
a
(See also, II below.)
11. The rate of paying for international calls at the
_.r.a_t~
_QC $J,3 .. 0.1 __ to~ _the._
firsL_Tl}in~t:._~_
and aver'"
'"T
aL$4..49 _. __.
for each additional minute is unconscionable.
THE DeD.C.'S AI,TERNATIVE TO INTERNATIONAl, PHONE CAI,J.S
12. The herein writer of this complaint submit that the
5
alternative
to
Global
Tel*
Link
not
having
international
phone call service provided has lead to the following;
13. On December 12,
filed
a
request
to
2009, via,
make
a
inmate remedy system,
phone
call
to
my
I
biological
children in Germany, stating that I would pay for the call(s)
made and the time to call.
(Ex. 1).
14. The form was dated December 1, 2009, as wrong form,
and Form IRSF
(Inmate Remedy System Form 103) was sent back
stating to see Unit Social Worker.
(Ex. 2).
15. I spoke to the Unit Social Worker Ms. Crystal Raupp,
and she submitted the form on my behalf on January 5,
2010.
(Ex. 3).
16.
On
January
14,
2010,
the
Prison
Classification
Committee denied the international telephone call request by
Ms. Raupp submitted on my behalf.
17.
Based
resubmitted
a
on
the
request
(Ex. 4).
denial
on
on
January
January
17,
5,
2011,
2010,
asking
I
for
reconsideration of the denial, and to show cause why I should
not be able to call my children to the Prison Classification
Committee.
18.
(Ex. 5).
Stamped
filed
January 20,
2010,
as
"wrong
form"
someone unknown in the Administration Department sent a IRSF
... Form. 1.0J_._stat_ing i
number
on
..
DebLt
IPIN
co 1.1e.ct ._.cg11s _.c<;l,u be__ made ,,-. __Pla~.e._
List,
Institutional/Department "Tel 005."
19.
Prior
to
January
20,
6
and
use
approved
(Ex. 6).
2010,
I
filled
out
a
Discrepancy
Form
requesting
to
add my
daughter,
son,
and
children's mother on the phone IPIN list.
20.
On January 21,
2010,
I
received response stating,
"No international calls through phone system."
21.
asking
On January
permission
to
22,
2010,
add my
I
sent
enough boxes
on
the
another
daughter,
mother's number to my IPIN list.
IPIN form
son
Also,
for
came
back
on
January
request
and
daughter's
the
digits
26,
of
2010
Again, I resubmitted on February 8, 2011.
I'm
requesting
that
both my
In response,
stating,
International calls. Only North American dialing."
22.
out
that there was not
daughter and her mother's phone numbers.
request
(Ex. 7).
the
"No
(Ex. 8).
(Ex. 9).
Global
Tel*
Link
provide
services to me on the "Inmate Pin Request Form" to call from
the
institution
pre-payment
to
of
an
overseas
inmates
through
account
collect
and/or
or
direct
international
(See, Ex. 10).
collect calls.
23. The number of slots on the IPIN Form should reflect
enough
digits
includes
needed
country
information
is
for
codes
international
and
already
number
covered
specifically for the numbers approved.
___ca_l-_I_G_ermc:l,ny,__ J~u_sSi_a_,__
phone
dialing
calls,
unless,
electronically
this
the
and
If an inmate wish to
~_r_C\.nc~_, _~opeDhag§I:L ~_t_
g:L$-,__ , __ th~ _QQ1.lptTI'_
codes can be electronically imputed into Global Tel* Link's
computer where the inmate is allowed to call directly to that
one number approved for dialing.
7
(Ex. 10).
24.
Global Tel * Link does not have anything in place
for inmates who have family overseas,
contact
them.
I
must
use
the
and wish to call and
Social
Worker's
Department
within the Department of Corrections to place an overseas
call
as
an
alternative
at
discriminatory
rates.
(See
scheduled calls vial For G-14 as Exhibits 11-15)
25. The overseas call is $57.00 to $60.00 for 15 minutes
at
$13.04
for
the
first
minute
and
at
$4.00
for
each
additional minute.
26. I request that Global Tel* Link, contract companies
overseas to assist clients (inmates)
families
I
.
who wish to call their
overseas without having to pay a
large disparity
compared to those made intra & interstate calls here in the
United States as unjust and unreasonable.
pIIRT,Ie INTEREST
27. The competitive price gouging from the families of
inmates does not promote rehabilitation nor does it promote a
stable
atmosphere
within
the
prison
come
Rates
for
prisoner phone
calls
families if
the rates for prisoner telephone calls should
SOl
should not
system.
from the pockets of
be equal to a comparable call in the free world including
the
prevention
of
any
special
surcharges
or
tariffs
I
on
. -prisoner--calls ;---- -- --28.
The rates considered are unacceptable to families
where current rates for local and inter-lata calls provide
lower
costs
to
inmate I s
families
8
when calls
are
made
at
night, on weekends and holiday, however, the families are not
getting the benefit of these discount rates.
29. A request is reasonable, and in the public interest
since,
when the process can be used on the pre-paid debit
account at a lower rate than paid by the public savings "tax
payers" and at the same time lower the complaint level in New
Jersey Department of Corrections.
30.
When an inmate cannot afford to pay for the high
rate calling through the alternate source (Social Worker), he
or she will receive a G-14 stating, the call can be made when
there
is
enough money
in
the
account.
(Referring
to
Ex.
11-15) .
31.
Under
the
request
for
proposal,
Inmate/Resident
Telephone Control Service was made to be most advantageous to
the
State,
price
and
other
factors
considered
however,
neither the inmate nor the families.
32. Under the dialing plan provided by the Contractor no
international calls is authorized.
33. No calls are permitted unless approved by the DOC
and/or JJC POCo
DISCRIMINATORY RATES
34.
In support of this claim,
complainant ask the FCC
--to -consider- --(Ex-;--16)- anart-icle---from--April --2011 -issue -of-Prison
Legal
News
(IIPLNII)
Vol.
22
No.4,
ISSN
1075-7678
which, did a national survey of telephone serVice providers,
GTL provides telephone service to correctional facilities in
9
20
states
and
as
a
major
operator
provider
in
the
telecommunications market. The complainant submit the Prison
Legal News (PLN) dated April 2011, shows Global Tel* Link as
a major operator provider in the United States.
35.
reduce
As of June 24,
the
cost
Corrections
(DOC)
of
2010,
Inmate
and
(Ex. 16.)
Global Tel Link agreed to
calls
Juvenile
at
State
Justice
Department
Commission
of
(JJC)
facilities by providing a flat rate for all calls of $0.33
per minute which equating at an overall
15% reduction and
providing
40%
modified
the
the
State's
commission
from
commission percentages
fro
to
some
41%,
and
the
rate
of
options available to county correctional facilities.
36. The lowest interstate rate is Massachusetts at
+
.10 for each additional minute.
The highest
.86
is Alabama,
Arkansas, Connecticut, Georgia, Minnesota, North Carolina, at
3.95 + .89 for each additional minute this does not include
the applicable taxes and fees.
37.
There
should be no ban from calling services
to
family members who are in possession of cell phones due to
the overwhelming use and ownership in society today.
38.
The failure to provide international call service
under the contract is also unreasonable .
. 39.__
fj.n~lly,
_. tj:le ..
pla_c~!TIept
__ <?f._ .?.Il.
autorn~t:;J_c
block as
described earlier in (paragraphs 6-9) is also unreasonable.
DISCRIMINATORY PRACTICES
40.
The
FCC
should determine
10
if
the
ban
on
inmates
calling cell phones is discriminatory.
41.
Whether
the
failure
to
provide
international
calling to inmates under the contract is discriminatory.
lIN.TIISI AND IINREASQNABI,E RATES
42.
New Jersey rates
show a
compared to the 20 states which,
disparity as
II
excessive II
also has Global Tel* Link
for contracts.
43.
The
Requestor
as
a
client
seek
the
Wireline
Competition Bureau to investigate whether the rates show a
disparity,
and should be equally across the board for all
states contracted with Global Tel* Link.
44. The Requestor, by way of informal request files this
to
determine
if
the
rates
are
unjust
and unreasonable
violation of the Communications Act of 1934,
in
and urged the
FCC to investigate the services to New Jersey State Prisoners
and to regulate their rates. This includes whether there is a
disparity in the phone rates in New Jersey compared to other
states and lack of cell phone use.
45.
Global Tel * Link,
therefore has a
market.
is a provider to 20 states and
dominant position in the operator service
However, the phone rates vary from state to state in
the market power.
(Ex. 16).
--- . - - 46.--- Global- Tel * --·-Link,·· is-- -a--maj or--onthe - market
should
treat
all
states
equally
on
a
and
non-discriminatory
basis.
47.
As
Global
Tel*
Link
11
has
a
contract
with
the
Department of Corrections here in New Jersey,
they
(D.O.C.)
are equally liable for not providing their rates to inmates
in writing upon request.
48. Due to the contract, I am compelled to use only the
debit
phone
system
when
I
need
to
speak
with
my
family
placing $15 to $20.00 for calls in the United States due to
phone blockage.
12
CONCI,JISION
(a.) The FCC should investigate whether Global Tel* Link
rates as a major on the market competitively, show disparity
from state to state as unjust and unreasonable;
(b. ) Whether the rates should be equally across the
board as Global Tel* Link is a major contender amongst other
carrier providers as unjust and unreasonable;
(c.) Whether the rates are unjust and unreasonable given
the prices of other states who are lower and by the same
carrier;
(d.) Whether or not, providing service for inmates who
have families outside the United States is prejudicial, and a
request is reasonable for Global Tel * Link to provide the
necessary service to those inmates, and if not, whether such
refusal would amount to a violation of 47 U.S.C. Section 201;
(e) That the Wireline Competition Bureau determine that
the maximum rate from Global Tel* Link of $.33¢ a minute in
New Jersey compared to other states under contract is in
excess of a just and reasonable rate pursuant to 47 C.F.R.
§1.1410(a) as a major on the market;
(f.) That Global Tel* Link, the above named carrier be
ordered to immediately provide telephone service to Inmates
in New Jersey Department of Corrections for foreign calls;
(g.) The FCC Investigate the disparity in the phone
rates, as the rates should be equally across the board to
avoid discriminatory acts;
(h.) The Service Provider Global Tel* Link should engage
in foreign communication in the publics interest. Such
interest where complainant now pay $57.00 - $60.00 for 15
minutes would be cheaper if paid and established through the
Inmate pre-paid account establish through Global Tel * Link
even at .33 a minute and for each additional minute;
(i.) Whether failure to provide the actual amount of
applicable taxes and fees under the contract is unreasonable;
(j .) Whether the Department of Corrections and Global
Tel*--- Link's agreement_to .33¢- a __ minute_ plus applicable_ taxes
and fees could be implemented without consent of the clients
(inmates). This is especially considering, the Department of
Corrections is profiting, and not paying any fees for the
purpose of this deal/contract.
This is especially so, where
there are Inmate representatives who speak on behalf of the
inmate population,
who could relate the agreement of
contracts between inmates and the prison officials.
13
Accordingly,
named
carrier
services,
are
the
be
undersigned
investigated
to
request
that' the
determine
discriminatory against,
and
whether
for
above
their
unjust
and
that
the
unreasonable rates.
Date: January 10, 2012
I
I
declare
under
of
perjury
foregoing is true and correct.
Signed this lOth day of Jan
~"-------"--
- ----------- - ------- --- -- ._------------ -- .. _-- -
14
- ..
----- .. -
Bobby Brown
#249446/#722093b
New Jersey State Prison
P.o. Box 861
Trenton, New Jersey 08625
Requestor Confined
Date: January 10, 2012
BEFORE THE
FEDERAL COMMUNICATIONS COMMISSION
WASHINGTON, DC 20554
In re:
Application of Bobby Brown
As An Informal Request For An
Investigation of Unreasonable
and Discriminatory Rates And
Practices
File No.
Docket No.
AFFIDAVIT TO PROCEED
IN FORMA PAUPERIS
To: Federal Communication Commission
Wireline Competition Bureau
Chief, Ms. Sharon Gillett
445 12th St., S.W. 5th Floor
Washington, DC 20554
To: Global Tel* Link
2609 Cameron Street
Mobile, Alabama 36607
,
Pursuant
to
47' C.F.R.
§1.224,
Bobby
Brown
moves
the
Presiding Officer Ms. Sharon Gillet for permission to proceed
in forma pauperis in the above captioned proceeding relating
to
this
informal
complaint and in support
of
this
motion
shows:
1. Movant is in a position to submit material relating
States to request an investigation as to whether the rates by
Global Tel * Link are unj ust and unreasonable as a maj or on
the market
,in
the United States;
15
and whether prison phone
calls
and
contracts,
are
prejudicial
to
inmates
who
have
families which live internationally abroad where there is no
slots for approve numbers on the inmate IPIN Form nor can
cell
phones be
approved
for
the purpose of
calling where
society land lines are clearly outdated.
2.
Upon
information
and
belief,
the
evidence
that
movants seeks to introduce is of substantial public interest
and importance,
and though,
submitted for public view,
the
FCC nor courts have made the conclusion as to whether the
rates are unreasonable, unjust and prejudicial.
3.
Movant
is
not
seeking
and
will
not
realize
any
personal financial gain from this proceeding and simply moves
for
an
investigation,
and
final
conclusion
based
on
the
moving papers submitted herein as exhibits.
4. Movant has dedicated personal financial resources in
the amount of $25.00 monthly from his monthly institutional
pay but inadequate for effective participation.
5. Movant shall rely further on the attached affidavit
in support of this informal request.
6. The Movant has submitted in support of his informal
request a copy of his inmate account statement supporting his
financial transactions for the last six months.
_7.
Movant
has
submitted
facts
showing
under all
the.
circumstances that it would not be reasonable to expect added
resources of his individual assets to meet the expenses of
participating in the proceeding; and an estimate of the cost
16
of participation.
WHEREFORE,
the undersigned moves the Presiding Officer
to issue an order:
a. granting this Informal Requesti
b.
Directing
that
a
copy
rules
of
of
the
decision
be
made
available tb movant; and
c.
Relaxing
the
filing of Informal Request,
to ease
Dated:
procedure
with
respect
and supporting copies,
burden.
~~~~~~~~~
17
to
in order
,.
"
Bobby Brown
#249446/#722093b
New Jersey State Prison
P.O. Box 861
Trenton, New Jersey 08625
Requestor Confined
Date: January 10, 2012
BEFORE THE
FEDERAL COMMUNICATIONS COMMISSION
WASHINGTON, DC 20554
In re:
Application of Bobby Brown
As An Informal Request For An
Investigation of Unreasonable
and Discriminatory Rates And
Practices
File No.
Docket No.
MOTION TO PROCEED IN FORMA
PAUPERIS
To: Federal Communication Commission
Wireline Competition Bureau
Chief, Ms. Sharon Gillett
445 12th St., S.W. 5th Floor
Washington, DC 20554
To: Global '1el* Link
2609 Cameron Street
Mobile, Alabama 36607
MOTION TO PROCEED IN FORMA PAUPERIS
Pursuant to 47 C.F.R.
§1.224,
I Bobby Brown, moves the
Federal Communication Commissioner for permission to proceed
in forma pauperis in the above captioned proceeding relating
to the herein informal request for action by the F.C. C.
investigate Global Tel* Link for discriminatory,
to
unjust and
of Corrections.
As
contract
complainant
between
is
Global
considered
Tel*
18
Link
a
II
client II
and
the
under
New
the
Jersey
·.
Department
collect
of
Corrections
having
his
calls
accepted
as
a
call and paying pre-paid calls due to unnecessary
blocks mentioned in the attached informal request complainant
has interest as a direct party and public interest for family
who are tax payers in and outside the United States.
Wherefore, in support of this request shows:
1.
Movant
has
submitted
via,
attached
complaint
evidence of probable decisional significance on the issue of
requesting
an
investigation
for
discriminatory
services,
unjust and unreasonable rates by Global Tel* Link.
2. The evidence that complainant seeks to introduce is
of substantial public interest and importance.
3.
Requestor
is
not
seeking
monetary
or
personal
financial gain from this informal request.
4. Requestor has dedicated personal financial resources
in
the
amount
of
$25.00
to
finance
proceeding which is reasonable,
the
funds
in his
the
request
in -this
as it is equal to a 3rd of
prison account,
and equal
to
any
legal
matter within the court system as an indigent inmate however,
inadequate for effective participation.
5.
the
Requestor request
personal
financial
that
the
Presiding
information
submitted
Officer hold
herewith
in
confidence.
6. As a prisoner I am subject to V.C.C.B. court imposed
fines and penalties;
7.
I
must
pay $5.00
for
19
any and all
doctor visits,
including $2.00 for all medications prescribed as a result of
my illness.
8. I must pay 10% on all commissary orders here in New,
Jersey State Prison;
9. I m~st pay $57.00 - $60.00 for all phone calls to my
son and daughter which is the heart of this complaint;
10.
I
must
pay 10¢
on all
copies
made
through this
institution.
WHEREFORE,
the undersigned moves the Presiding Officer
to issue an order:
a. Granting this motion;
b.
Directing
that
a
free
copy of
the
transcript
of
testimony be made available to complainant; and
c. Rel~xing the rules of procedures with respect to my
indigence status as a prisoner in order to ease my financial
20
Received & Inspected
SEP -42012
FCC Mail Room
Bobby Brown
#249446/#722093b
New Jersey state Prison
P.O. Box 861
Trenton, New Jersey 08625
August 3, 2012
Ms. Jean Ross, Esq.
32 Markham Road
Princeton, New Jersey 08540
Re: F.C.C. Complaint
Dear Ms. Ross:
Please find enclosed, a copy of the "exhibits" to the F.C.C.
Complaint.
on my
Please
attached
(population's)
behal f •
when
I
no one is
send
the
complaint out
have also, enclosed a copy of
the check in the amount of $25.00.
but,
you
The complaint was misplaced
saying where the money went either which, was
for the purpose of indigence.
I
hope that by presenting the complaint itself,
this will
be enough to speak for myself and the entire inmate population
~he
since, we're all under
Anything that
me know for
I
same contract obviously.
can be of assistance to you,
there is so much work to be done but,
time to complete the tasks.
Thank you for your time!
Submitted,
C: BB File,
Inmate Legal Ass'n, Inc ••
please let
so little
PLEASE SUBMIT THIS FORM INTO THE INMATE REMEDY BOX
ONLY TO BE PROCESSED
(SfRVASE PRESENTAR ESTE FORMULARIO EN LA CAJA DE REMEDID DEL CONFINADO SDLAMENTE PARA SER TRAMITADO
Revised 112008
Form: IRSF 101
N.J.A.C.10A:1-4
'.
NEW JeRSEY DEPARTMENT OF CORRECTIONS
[DEPARTMENTO DE CORRECCIONES DE NUEVA JERSEYl
INMATE REMEDY SYSTEM FORM
[FORMULAlUO DEL SISTEMA DE REMEDIO DEL CONFINADO)
• • • • • n •• p' • • • • • • • • • • • • • • • • • • • • • • • • • n •• n • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
INMATE'S REMEDY OR COMPLAINT AREA:
IPART [PARTE] ,1 I
[AREA DE REMEDIO 0 QUEJA DEL CONFINADO]
TYPE OF REQUEST
[TIPO DE PETJCION]
b?1ROUTINE INMATE REQUEST
(Only Chackone box)
(Lien. sol.ment. una c.aJUa)
lNMATE'S NAME<
INOMBRE DEL CONFINADO]
~TICI6'. RUTINARIA DEL CONFINADOI
~
4;w",,,,
INSTITUTION: /IJ . .':; .t;, .
HOUSING UNIT:
(INSTITUCION]_
[UNIVAD DE VIVIENDA]
o INTERVIEW REQUEST
SBI NUMBER: IQ~()q 3 fa
DATE: /.2- i/).- D9
[PETICION PARA UNA ENTREVISTA)
(NUMERO DESDI]
~&
(FECHAJ
CI'a$~/tdc>--t'b.N 7~c.t'oj LJ()ft~R JJ-e,pf,t
(
. form. DOC Corrective Action form issued with paragraph(s) #
[No se tom611inguna medida en este for
(PART [PARTE] 2 ~HE ABOVE INMATE
[EL COORDINADOR DETE
indicado(s).]
OIt:vtATION WAS DETERlVITNED BY THE COORDINATOR AS ONE OF THE FOLLOWING:
N6 QUE LA INFORMACl6N ANTERIOR DEL CONFtNADO ES UNO DE LOS SIGUillNTES]
DROUTINE INMATE REQUE~
DINTERVI5W REQUEST
[PETICION RUTINARIA DEL CONFINADO)
[PETICION PARA UNA ENTREVISTA)
SUBJECTOFREQUEST:,_______________________
RECEIVED BY:
[REcmrooPOR]
marked.
-io. Se proveyo el formulario de Action Correctiva del DOC con el (los) parrafo(s) #
----------------
[TEMA DE LA PETIcx6N]
DATE FORWARDED TO DEPARTMENT:
[FECHA EN QUE SE ENVI6 AL DEPARTAMENTO]
DA
RESPONSE RETURNED TO IIM:
[FECHA EN QUESE DEVOLVI6 AL CONFINADO] - - - - - - - - - - -
-------
DEPARTMENT RESPONSmLE:
CASE NUMBER:
[DEPARTAMENTO RESPONSABLE]
[NUMERO DEL CASO;-]--;;YE=AR7';;"'----,M=ONT=H:;------;;E;;;X:;::;C;;;EL;-L;-;INE=--
• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • u •• [~~~ • • • • • •
IPART [PARTE]
31
~~J.~ ••••• ~~:~~~~~ ••
STAFF RESPONSE AREA [AREA DE RESPUESTA DEL PERSONAL]:
Attachments: From Inmate: ______
STAFF SIGNATURE
DATE [fECHAJ
(fiRMA DEL PERSONAL]
[Documentos adJunlos: Del CouDnado]
From Staff: _ _ _ _ _ __
[Del Personal}
SIGNATURE OF ASST SUPT OR APPROPRIATE ADMINSTRATIVE DESIGNEE
[mAlA DEL 5UBSUPT n LA PERSONA ADMINISTRATIV A CORRESPONDIENTE DIlSIGNADA POR EL]
•• " " " " "
•••••••••••••• D •••••••••••••••
IPART [PARTE] 4
DATE
•
[FECHA]
DOC Staff Response forms:=c.--_ __
(Formulnrio. de Respuesta del Personal del DOC]
a •••••••• D •••••••••••••••••••••••••••••••••••••••
~NMATE'S ADMINISTRATIVE APPEAL INFORMATION [INFORMACI6NDE APELACI6N ADMINISTRATIVA DEL CONFINADOJ:
Form: IRSF 103
N.l.A.C.10A:1-4
INMATE'S NAME:
NEW JERSEY DEPARTMENT OF CORRECTIONS
INMATE REMEDY SYSTEM
CORRECTIVE ACTION FORM
6ND-\LO
SBI#:
.
Revised ](2008
"J a-21PQ3 b
Location/Housing Unit: _____L!-4-L-A->--_______
The below corrective information should be used and followed when submitting for information to
Institutional staff on a first time basis. Please take the action noted next to the letter X.
1. 0 You must complete the following form marked below and place it into the correct box or send by Truck MaiL
o EducationlLaw Library Form and Box.
OOffice of the Ombudsman, Request Form and Box.
ODOC Government Records Request Form (OPRA)
DDOC, Health Services Request Form and Box (MR-007)
DIIM Claim for Lost, Damage Prop (Form 943-1)
DRequest for copies of MedicallDental Records (MR 022, 301-Xll)
2.0 You must submit a NJDOC Job Change Form. Once you have completed the form, it must be handed in to your debl superyi~or.
Only the detail supervisor can turn our request into Classification; QB A Staff member must submit a staff referraL The staff member must
deIiver7referr
appropriate e
ent. ONLY staff members can follow-u on com
3. ~leas see your Unit Social Worker to omplete the appropriate forms for programs,
er related services, d information to include
but not be limite
, irth Certificate, ISP, ASIITC, CRP process, Cage our age,
V and Thinking for a Change.
4. 0 The form you submitted did not contain SPECIFIC information. Please add additional information and resubmit.
5.0 Your Inmate Remedy System form contained more than one (1) question, which cannot be handled on the same form. Please
familiarize yourself with information on the Remedy System that is listed in the Inmate Handbook and resubmit another Inmate Remedy
System form.
6. 0 Your Inmate Remedy System form was deposited into the _ _ _ _ _ _ _ _ _ _ _.Box. Please place your Inmate Remedy
System form into the Box Marked "Inmate Remedy System Box".
e the NJDOC Tele hone IPIN s stem ou need to follow the below rocess: (Up to 30 days to process forms)
O. NJDOC IPIN Assignments UPDATES will be completed on a quarterly basis within your current facility.
O. Telephone System Discrepancy form can be completed at any time. please retlLTf'}ceposit into the _ _ _ _ _ _ _ _ __
I
8. 0 The information that you submitted must be placed on the Inmate Remedy System form and placed into the Inmate Remedy System
Box. This will ensure proper tracking of your request. If the form is a similar question or a possible duplicate, please do not resubmit a
9. 0 You submitted the attached letter, form or application into the Inmate Remedy System Box. That box is for the Inmate Remedy
System forms only. Please place the letter, form or application into the US Mailbox or _ _ _ _ _ _ _ _ _ _ _ _ _ __
10.0 You cannot use the Inmate Remedy System form for DOC disciplinary charges or DOC disciplinary charge appeals.
11. 0 You submitted your request to the person or department not authorized to handle the Inmate Request System form. The form must be
placed into the Inmate Remedy System Box in order to be processed correctly.
12.0 yOur request for Face Sheets, Progress Notes, and Psychological or Medical evaluations cannot be processed. That information is
provided or conducted during specific times during your incarceration.
13.0 Your request for an updated adjusted Max Date and/or Parole Eligibility Date (PED) is being returned because that information is now
provided on a monthly basis on your Inmate Trust Account Statement for informational purpuses only. If you feel your max and/or parole
information is in error, justify the error and submit :l.'lother L"lInatl! Remedy Sysrem form. Ir should al~u DI! n0ted thaI your work &
minimum credits DO NOT get updated al the same time as your Inmate Pay.
14. 0 You cannot write or mark in the shaded area of the Inmate Remedy System form.
15. 0 Your form is a follow-up question or Appeal to a previous submitted form. You must re-submit your answered form, within 10 days
of receipt, with additional information, within Part 4 and place it into the Inmate Remedy System Box for further processing.
16. 0 This is a duplicate request that is not permitted. Staff is granted up-to a 30-day response time on all requests.
17. 0 The facility uses an approved Institutiona1JDepartment form to handle this matter. The form is _ _ _ _ _ _ _ _ _ _ _ __
_ _ _ _ _ _ _ _ _ _ and the form can be recei,:ed fromyour _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
__________________________________________________________________________
18.[JOth~
!II
~.
NEW JERSEY STATE PRISON
SOCIAL SERVICES DEPARTMENT
MEMORANDUM
TO:
Ms. C. DeCristi, Classification SupeNisor
FROM:
Crystal Raupp, Social Worker 1
DATE:
January 5, 2010
SUBJECT:
Brown, Bobby #249446/722093B
x:;;)
e:;:
Please be advised that 11M Brown, Bobby #249446/722093B (4A) has requested
approval for an International Telephone Call with his daughter, Giulia Wolf who
currently resides in Germany. I have verified the relationship through 11M
Brown's Pre-Sentence Investigation Report. Please submit 11M Brown's request
to the Prison Classification Committee at your earliest cC!nvenience. Thank you.
cc:
11M Brown, Bobby #249446/722093B (4A)
file
/15/2010 15:3J.
IIFLET
)0722093B
Page
NEW JERSEY STATE PRISON
Meeting Results - Inmate Notification
INSTIT CLASS COMM
From 01/14/2010
To 01/14/2010
Last Name
BROWN
First Name
BOBBY
2
of
OIRNIICC
MI
SFX
L
)cation
JSP-NORTH-4 A-CELL 40; :
he results are as follows:
=quest Type
iON
For (Reason)
Result
Date
REV
DENIED
01/14/2010
Reasons/ Comments:
Referral
Action Of Committee
REVIEW
DENIED INTERNATIONAL TELEPHONE CriliL(S)W1TH DAUGHTER GIULIA WOLF WHO CURRENTLY
RESIDES IN GERMANY _ /MF
27
Form: IRSF 103
N.J.A.c. lOA:l-4
INMATE'S NAME:
NEW JERSEY DEPARTMENT OF CORRECTIONS
INMATE RE:MEDY SYSTEM
. CORRECTIVE ACTION FORM
5/l:'-{i V1
t1"1
Revised 112008
I2-OV q~
SBI#:
y--'-_A_____
-5
LocationIHousing Unit: _______
The below corrective information should be used and followed when submitting for information to
Institutional staff on a first time basis. Please take the action noted next to the letter X.
1. 0 You must complete the following form. marked below and place it into the correct box or send by Truck Mail.
o EducationlLaw Library Form. and Box.
OOffice of the Ombudsman, Request Form. and Box.
ODOC Government Records Request Form. (OPRA)
ODOC, Health Services Request Form. and Box (MR-007)
OIfM Claim for Lost, Damage Prop (Form 943-1)
DRequest for copies of MedicallDental Records (MR 022, 301-Xm
2. 0 You must submit a NJDOC Job Change Form. Once you have completed the form., it must be handed in to your detail supervisor.
Only the detail supervisor can turn your request into Classification; OR A Staff member must submit a staff referral. The staff member must
deliver the referral to the appropriate department ONLY staff members can follow-up on completed forms.
3. 0 Please see your Unit Social Worker to complete the appropriate forms for programs, other related services, and information to include
but not be limited to: Social Security Card, Birth Certificate, ISP, ASIITC, CRP process, Cage Your Rage, FOV and Thinking for a Change.
4.
0
The form you submitted did not contain SPECIFIC information. Please add additional information and resubmit.
S. 0 Your Inmate Remedy System form. contained more than one (1) question, which cannot be handled on the same form.. Please
familiarize yourself with information on the Remedy System that is listed in the Inmate Handbook and resubmit another Inmate Remedy
System form..
-lr-~Lt'YlJllrimnalu~led,~S~sgte~m~fo~rm. was deposited into the
IDa~
Box. Please place your Inmate Remedy
"Innia.tete::::~~:~"~::::::~~~;;;t~;jprocesi:(Wt03UQliYS1tlTp:~!!iS-fOmtSL_ __
System
into the Box Marked
7.
process, correct or update the NJDOC Telephone !PIN system you need to follow the below process: (Up to
a
D. NJDOC!PIN Assignments UPDATES will be completed on a quarterly basis within your current facility.
). I
. Te1ep,hone System Disc~1;'~cy form. can be 90mpleted at ao.¥ time, J'l.,q:tse retumldeposit into the
U"rr:
c/ol t~
Cc0lJL..D
~ \O..L-
m0:-&J2..·
l--'C o,U...
n tJrtJioJ.-1
t'Vl
A"
l Fh.J
t -.
!
IS7,
8.
Tne information that you submitted must be placed on the h"lIl'late R~medy System form and placed into t.~e Inmate Remedy System
Box. This will ensure proper tracking of your request. If the form is a similar question or a possible duplicate, please do not resubmit a
new form.
9. 0 You submitted the attached letter, form or application into the Inmate Remedy System Box. That box is for the Inmate Remedy
System forms only. Please place the letter, form. or application into the US Mailbox or _ _ _ _ _ _ _ _ _ _ _ _ __
10.0 You cannot use the Inmate Remedy System form for DOC disciplinary charges or DOC disciplinary charge appeals.
11.0 You submitted your request to the person or department not authorized to handle the Inmate Request System form. The form. must be
placed into the Inmate Remedy System Box in order to be processed c~rrectly.
12.0 Your request for Face Sheets, Progress Notes, and Psychological or Medical evaluations cannot be processed. That information is
provided or conducted during specific times during your incarceration.
13.0 Your request for an updated adjusted Max Date and/or Parole Eligibility Date (PED) is being returned because that information is now
provided on a monthly basis on your Inmate Trust Account Statement for informational purposes only. If you feel your max and/or parole
information is in error, justify the error and submit another Inmate Remedy System form. It should also be noted that your work &
minimum credits DO NOT get updated at the same time as your Inmate Pay.
14.
0
You cannot write or mark in the shaded area of the Inmate Remedy System form..
15. 0 Your form. is a follow-up question or Appeal to a previous submitted fonn. You must re-submit your answered form, within 10 days
of receipt, with additional information, within Part 4 and.place it into the Inmate Remedy System Box for further processing.
I
16.
0
Thi s a duplicate request that is not permitted. Staff is granted up-to a 30-day response time on all requests.
17.' The facility uses an approved InstitutionalJDepartment form. to handle this matter. The form. is
_ _ _ _ _ _ _ _ _ _ and the form can be received from your
\,f:,Y 07~
18. [] Other___________________________________________________________________________
.I
New Jersey Department otCorrections
Telephone System Discrepancy Form 8f'A.ttorney Change Form
&
Inmate Name:
:5 ~ f.p i 3 5
.Ho~g Locat~:_U.. !,f. .:. .,y-,--/_ _ __
36
SBI#: 15<:'< L.-""'1
.X-l 15,.t.OW..IV
J~ /Cf·
A.JL. /~--<-e.../',,,,,
.!) 0 10
Signature:
If you are reporting a problem with your IPIN, please complete the following: Be speciik.
IPIN Number:
Date:
0 ~
=
Telephone number(s) being c?l1ed: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _._ _ _ _ _ _ _ _ _ _ _ __
Location of Inmate Telephone being used: _ _ _ _ _ _ _ _....:Date: _ _ _ _ _Time of call: _ _ _ _ _ _ _ _ __
Exact nature of problem and/or concern. What message are you hearing when attempting to call this particular number?
..L
fWD ,jAc,u..{; ..-
/lave
/111,.{Jli·c.....
tv/sf)
.L.
10 add
10
FlA-LI
'r.;r-: .
/JjlD.,(..J~
~_.
~-f',
";e.../'-r1"
IA_H'\.o\Q'f'/.!~
,.D Mu. . ::::./'l-ttCi
o..u -/ I/,{-.;.
~ t1~ ~ . of&U.0.J"c :.Q ({."
,
.... •
.
, ) _ _,. .
.
If you are reporting'api:'oble~ With a telephohe in your unit, please c'omplete the following:
,If,
a...vlfHi.IA>~
fc>
. V
,...v
I
OIQt:..
,\
·r.;.;
.A./W;1..Z..Ik.I'_
/
'e
,.)
Location of the Inmate Telephone being used: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _- - - - - -_ _ _ _ _ _ __
Circle what may need to be repaired: No dial tone; Broken Handset; B'uttons not working; Other._ _ _ _ _ _ _ _ _ _ _ __
NOTE: There are reasons that may cause your call to disconnect. For example:
> Accepting call waiting or call waiting tone
> Call forwarding
> Pushing or tampering with buttons, switch hook or receiver during call ,
> Picking 'Up or hanging up a second phone on the called party end or attempting to make a 3-way call
» CaJUng cordless pbones or cellular pbones
-' "
Attorney Add:
Attorney Name: _..,.-_ _ _ _ _ _ _ _ _ _ _ _Phone Number: (
, Street Address:
.: ) _',_ _ _ _ _ _ _ _ _ _ _ _ _ _ __
City and State: _ _ _ _ _ _ _ _ _ _ _ _ _ __
Attorney Delete:
Attorney Name:.~_ _ _ _ _ _ _ _ _ _ _ _ _ _ Phone Number: (......_____) _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
PLEASE DO NOT WRITE BELOW TIDS LINE
Telephone Discrepancy & Attorney Change Response Form:
Your Attorney has been (circle one) added/deleted from your IPIN as you requested.
One of the following answers applies to your complaint:
The customer has a collect block from their telephone company and they must contact them for further assistance; ..'
The customer must contact Global Tel*Link to establish a pre-paid account at 1-800-483-8314 or 1-866-230-7761
The telephone number you are trying to call has been disconnected or is no longer in service.
.
.
The telephone number you are attempting to call is not on your current IPIN list. You may add this number during the next
...--...,------.."
,f /
change period in ____________
\
i The
problem has been resolved and calls can now b( made.
II ) c/
! Other: /
\ ___ - .........-
£..
:
::t
~
,
I
/,/J. e...•.\. }\(- 1-
f
(c }1..A..
,
\.\ 1(\ (C-LC. '" ~l
I
Service Administrator: _____\\...-'(""'~'--__
Date:
(
I
TEL-005 (11-07)
Distribution: WhiLe: SAT
:t'.
'/)
,)(, /
I
7 ( /
I
If)
•
Yellol Inmate
'I:dt._
.
.
New Jersey Jlepa.rtment of Corrections
Telephone Sy~e~piscrepancy Form & Attorney Change Form
'-:;< - ~ ':.:..:2. G/t"3S'
-. (.
Inmate Name: -,-...:..:>5d-=-,=,~,-,L=-=,L.(-\--~~=.c-:i.....:.;-O=:..--u...:>::......u-=:..-_ SBI#:
IPIN Number:
'7zz6Q 3h
B;ousing Location:
Date:'/
.
Signature:
----'-=-==----'-'-'='-'----'-"'---
If you are reporting =:t problem with your IPIN,
:f:-:.<..!~
~
~~. 4! 0
Be specIfic.
Yt4-
6A./.Od"-£'
. : .
Va.
'E.
K.
Telephone number( s) being called:
Location of Inmate Telephone being used: ___'-f--'---'-4....1-_ _ _--..:Date: _ _ _ _ _Tirile of call: _ _ _ _ _ _ _ _ __
Exact nature of problem and/or concern. What message are you hearing when attempting to call this particular number?
<-3, l
:
(' 12...0
+II E~..e.
.A.).ur1A-.b-e_tK.5
to f
~~af' :1'." D..u~C;:" ~ e·k.; ~(L7 "\l-\'Q5~
i-o C~<!~ 141~
'---ri.,
?.c, AJ()f•
€t!Q
'..0..,0
.) \61. c
o!2..{:,
(?
J a...v v'V\..u \ ; "S1- 0 ...D~ ~ i-R.~
~d{(~~' N f~ ..ui~Jl t Xj~I\/)l
IlI'kAjcC;;
')() ,.:
<;
J",
.J
.
c.a.u.s,
-O:R ~1 'P
~ ~.L. '.AAJ.~ Oll....-U.)
,)~"2- '.:O.\d-~..v d-Q...~'-\ ~
If you are reporting a problem wilna telephone in your unit, plea~e complete the foUo~ng:
T
Cc....v
~-\ ,~('f) bx.
('-\'
){S'3,
_J
Location of the Inmate Telephone being used: - - - - - - - - - - - - - - - - - - - - . - - - - - ; r - - - . . . - - - - - ,
Circle what may need to be repaired: No dial tone; Broken Handset; Buttons not working; Other 'T' ..l.rll.!<./I., t )oj.j Q r'\JO
0S1
1
tl.s \
NOTE: There are reasons that may cause your call to disconnect. For example:
>- Accepting call waiting or call waiting tope
>- Call forwarding
" ..
>- Pushing or tampering with buttons, switch J;too~ or receiver during call
Picking up or haBging up a see6nd pho!,S on the called pal ty end or attempting to make a 3-way can
> Calling cordless phones or cellular phones
»
AttoineyNa~6:'~"" ,. .
- ',-:: . ".. .,
-, ':-..~ ,;.~' ',': ::.:.:
.
',"
~
',':.
..,....'
!' ..
-
11'.
PLEASE DO NOT WRfllE BELOW TIllS LINE
Telephone D~~rep~ncy & Attorney Change Response Form:
Your Attorney has been (circle one) added/deleted fr?m your IPIN as you requested.
One of the following answers applies to your complaint:
The customer has a collect block from their telephone company and they must contact them for further
as~istance.
The customer must contact Global Tel*Link to establish a pre-paid account at 1-800-483-8314 or 1-866-230-7761
The telephone number you are trying to call has been disconnected or is 'DO longer in service.
The telephone number you are ll;ttempting to call is not on your current IPIN list. You m~y add this number during the next
.
" :
change period in _ _ _ _ _ _ _ _ _ _ __
/
--
The problem has been resolved and calls can now be made.
I
(·Oth~~~:~--~/~G~G~0----~-r~i~/~LJ~,-LIL~"v~,4~~~~(~.~~~,~,.~~.,.~~!~(--~(~t~~.~f~i_________________________________~-._
.'~~--~------~----------~~------~--~~--~--,/'.1, ,/'
__
I
/iA
Lt
k
(;
:{;'J-H~
(\;~!t
Ser'-0.ceAdministrator: _ _ _-~----==--__
TEL-OOS (11-07)
;~!I'~
';lil
Dls;ributim"
Date:
()/l .Ji..7~/3
/ ifL.-.,
White: SAT
I
I
Yellow: Inmate '.
1-1/
-
'-
'
'
New Jersey J1epa.rtment of Corrections
Telephone Sy~em....Discrepancy Form & Attorney Change Form
;I#:.' '7Zz b Gf 3b
'
Inmate Name:
!PIN Number:
'iibb!j ~ 2olDo-U
'5::2 <.c, S 35
Date:
I - ;J Q. - ~o / ld
~9using Loc~tion: Yt4-~ciO 6A.f.9-t&
Signature:
r-.
va f-(t:'-»'E: cC
If you are reporting a problem with your !PIN, p~cOT:W~§~I~: Be specIfic.
Q/7ip - 0~ - q8 : 7t65?'
Location of Inmate Telephone being used:
't-4
Date:
Telephonenumber(s) being called:
0/7(- -
b,
75- -03 - 7/30
Time of call: _ _ _ _ _ _ _ _.,--_
Exact nature of problem and/or concern. What message are you hearing when attempting to call this particular number?
Location of the Inmate Telephone being used: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.--_ _-.,._ _ _.-_--,
Circle what may need to be repaired: No dial tone; Broken Handset; Buttons not working; Other 'I..I,rl o.J<./l" l
Q "'JC\
Q{\
i:;.1,
1
\ks I
NOTE: There are reasons that may cause your call to disconnect. For example:
~ Accepting call waiting or call waiti41g tope
~
Call forwarding
.,
~ Pushing or tampering with buttons, switch;ook or receiver during call
~ Picking up or 'hanging up a second ph0ilt on the"called party end or attempting to make a 3-way call
~ Calling cordless phones or cellular phones
.'.-".
.
;
,
,'~,
~
*
" ••
.~.>-' ~!~~<:'"~',,-.~!~ .. "~'.
....
...
.~
'~-:
~.l-h:·'~-':£:.:~~·''':::*/.... ~\,
'''",
.
'~~
.
;
PLEASE DO NOT-WRIN: BELOW TIllS LINE
.
~
Telephone Di§.Crep~ncy & Attorney Change Response Form:
Your Attorney has been (circle one) added/deleted fr?m your !PIN as you requested.
One of the following answers applies to your complaint:
The customer has a collect block from their telephone company and they must contact them for further assistance.
The customer must contact Global Tel*Link to establish a pre-paid account at 1-800-483-8314 or 1-866-230-7761
The telephone number you are trying to call has been disconnected or is 110 longer in service.
The telephone number you are
~ttempting
to call is not on your current IPIN list. You may add this number during the next
...
~
change period in
/---
-------------
The proble~ has been res~lved and c~ls c~n now be made.
~
I
(Oili~;~!--~I~/[~·G~~----~~~,'~/~t/~'wlc~,"-,~~~f.~~~(~"~;.~/~(--~(-c6~r~i-------------------------------I
{
fl I
________
seMce Administrator:
-
TEL-OOS (11-07)
D1SJibutiol"
r; . . I
f I~"
Date:
l
'
j
I (
" )
-(
II
White: SAT
/1
/ /',
'-
Yellow: Inmate,'
-
WLJ
INMATE CONTACT FORM
G-14
4. INMATE NAME:
1. INSTITUTIONAL I.D.:
2.STAFFI.D.:
UU
: 3. DATE OF: CONTACT:
11
,12
13
14
15
16
17
J8
19
20
21
22
99
(
/~
t'iLAAJIl
')
7,~ ;)U'Jj) 1.(
5. S.B.I. # _ _ _ _ _ _ _---'=U~ _ _ _ __
W
4A -3/.
Intake/Orientation
Administrative Referral
Classification Preparation
Formalized Counseling Session (Individual)
Routine Meeting
Inmate Request
Other Inmate
Correction Officer Referral
Community Agency Referral
Family Referral
Other Institutional Staff Referral
Crisis Intervention
Other _ _ _ _ _ _ _ _ _ _ _ _ _ __
45 -- Classification Counselor
46 -- Classification Committee
47 -- Business Office
48 -- Psychologist/Psychiatrist
49 -- Work Release
50 -- EducationalNocational Program
51 -- Medical/Dental
.
52 -- Custody
53 -- Furlough Coordinator
54 -- Institutional Parole Officer
55 -- Parole Board Counselor
56 -- Outside Agency
.
57 -- Community Treatment Services
8. PROBLEM IDENTIFICATION (Check those Applicable) 58 -- Inmate Association
58 -- Other _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
19 -- Drug.
20 -- Alcohol
(~' Referral Not Necessary
r
21 Homosexual Assault Behavior
22 -. Mental/Emotional
23 -- Administration
24 -- Cust.ody
25 -- Community Release
26 -- Parole
27·-- Furlough
26 -- Death Bed/Funeial
.29 -- Work Release
30 -- Medical
31 -- Family
'32 -- Adjustment Committee
33 -- Legal/Court
34 -- Business Office
.- 35 -- Claims
36 -- Mailroom
37 -- Institutional Behavior Attitude
38 -~ Programming Opportunities
.. 39 -- Institutional Job Assignment
40 -- Institutional Housing Assignment
41 -- Institutional Time Discrepancy
42 -- Custody Status
If -- None \ J. i; r ";'--. 1-"'" -:--) f\ ":""'1
Other
':~_.;
U : \,l A_:
/t;~--
COMMENTS:,
i /1
JI:
,r~'4
( "A,I
,J\\
'--./ '
I.
,
..
.
.• ,__;/ • "'::..J'
,
,
\
'I:
I U',
.
'/' "
'
1'--6H'__ Counseled Inmate
64 -- Informal Communication
65--0ther ___________________
11. INDICATE FUTURE SERVICE PLANS:
66 -- Follow-up with the inmate
67 -- Follow-up of the Referral
68--0ther _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___
(..
I
,
,J
//);'
~_ d}'
,
hI',I
'
I;
~
\
(!
..../
.' '.j ./'
/.
"
61 -- Report Written
,::£32 ~- Information provided
", /.,,; .
-'
........
'""
r..
I,
10. INDICATE WHICH SERVICE WAS PROVIDED:
(Check those Applicable)
/./
I 'i -'
''''-./.
/- ~"
ni,/~j
.j\
i
,: /..
,. '
/
U ( .J
i,,: ! {
,"
,
I
/~.t i(!,
I
)' /'
.('
!
A :, '
,
i'
I:
., ' \',,!-,... ~,'..
!
I
•
--
j ........
!/,!
)'L..:'1'-
-Ii'I
, . ' : ,• . ,
.' " , 1'" ~.'
/f
J
l1. ! ~
'.
\ .........
.,'
1 /
'1,
1,1.
'.;
.. 1\
, 1:"\
;,.1
\
.v·~·.
I
I' [I
, I,
' ,
~
L
.. to;:.,i··
: \
I
i'. .
!
Ex./1
1"-
!/ )
j
{
\ PLEASE SUBMIT THIS FORM INTO THE INMATE REMEDY BOX ONLY TO BE PROCESSED
\
"
[SfRVASE PRESENTAR ESTE FORMULARIO EN LA CAJA Dc REMEDIO DEL CONFINADO SOLAMENTE PARA SER TRAMITAOO]
Revised 112008
Forrrz: JRSF lOJ
N.J.A.C. lOA: 1-4
NEW JERSEY DEPARTMENT OF CORRECTIONS
[DEPARTMENTO DE CORRECCIONES DE NUEVA JERSEY]
\
••
~ ••
IN~!~!I!!~~!~~R~M!~!~C~FI~A?o~M
' •••• ' •••••••••••••••••••••••• a ••••••••••••••••• ••••••••••••••••••••••••••••••••••••••
IPART [PARTE] 1 I
INMATE'S REMEDY OR COMPLAINT AREA:
[AREA DE REMEDIO 0 QUEJA DEL CONFINADO]
TYPE OF REQUEST
[rIPO DE PETICION]
D INTERVIEW REQUEST
fi(f ROUTINE INMATE REQUEST
(Only Check one box)
~TICI6N
(Llene .olem.,,'. una collta)
RUTINARIA DEL CONFINADO]
[PETICI6N PARA UNA ENTREVISTA]
INMATE'S NAME: -L..,..L.:a...~~::l).-~~.!::=:~\..C::alo.....I~bc......l ~lPtl.) _ _ __
INSTITUTION: N.J .:'\, ?_
\)
[NUMERO DE S8I)
DATE: ,;2 19;
HOUSING UNIT:_Y"",H...L.-_ _
[IN~nTUCI6N1
,
I (I)
r,
[FECHA]
[UNIDAD DE VIVIENDA)
:'
/2!2cR3b
s~n NUMBER:
[NOMBRE DEL CONFlNAD01
c.
-',I.
• • -. ,.'I! • • • • • (.~• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ~ • • • • • • • • • • • • • •
~ St;I \-' i\-.t.... N'o action taken on this form. DOC Corrective Action form issued with paragraph(s) #
marked.
[No se tom6 ninguna medida en este formulario. Se proveyo el formulario de Accion Correctiva del DOC con el (los) parrafo(s) #
indicado(s).J
(PART [PARTE] 2 ~HE ABOVE INMATE INFORMATION WAS DETERMINED BY THE COORDINATOR AS ONE OF THE FOLLOWING:
-
/
[EL COORDINADOR DETERMINO QUE LA INFORMACI6N ANTERIOR DEL CONFINADO ES UNO DE LOS SIGUIENTES]
0
UROUTINE INMATE REQUEST
[PETICI6N RUTINARIA DEL CONFINADO]
INTERVIEW REQUEST
[PETICI6N PARA UNA ENTREVISTA]
.. ROUTINE
OR URGENT
(RUTINARIO 0 URGENTE]
,17 (.,.
RECEIVED BY:
SUBJECT OF REQUEST:
1.
[RECIBIDO PORI
DATE FORWARDED TO DEPARTMENT:
::::;:;::::;:::~:~IENTO~:,; G
[DEPARTAMENTO RESPONSABLE]
.--
r.
.i
C "
'-.,) ,.
(TEMA DE LA PETK10N)
11.1 !J
."
.[,,7 W" '{,1
I
1>,
.
.... , .
DATE RESPONSE RETURNED TO 11M:
('/J
-'-
,1 i.
( (( /'..)
!
~"f.
,.J."
I ()/)
"
~!_ IC\~
G'L... __\
:::=:::EVOLVI/C,~ONmNADZC1
Ela Ll
[NUMERO DEL CASO]
EXCEL LINE
YEAR
MONTH
[AFio]
[MES]
I
[LiNEA DE EXCEL1
•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
IPART [PARTE]
STAFF RESPONSE AREA [AREA DE RESPUESTA DEL PERSONAL]:
31
Attachments: From Inmate: _ _ _ __
STAFF SIGNATURE
DAT'E [FECj]
[FIRMA
"\ \
.,;;) f:::t.
SIGNATURE OF ASST S
ROPRIATE ADMINSTRATIYE DESIGNEE
[fiRMA DEL SUBSUPT 0 LA PERSONA ADMINI
•••• ,
•••• !
TIV A CORRESPONDIENTE DESIGNADA POR ELJ
[Documentos adjuntos, Del Confinado]
From Staff: _ _ _ _ __
\''''
DAT~ [FEcaAJ
[Del Personal]
DOC Stafr Response forms: _ _ _ __
[Formularios de: Respuesta del Personal del DOC]
• • • • • • • • • ~ • • • • • • • • • • • • • • • • • • • • • • • • • • ~• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •
IPART [PARTE] 4 ~NMATE'S
ADMINISTRATIVE APPEAL INFORMAnON [INFORMACION DE APELACION ADMINlSTRATIVA DEL CONFINADO]:
i
INMATE CONTACT FORM
G-14
WW
~ \-~J
j \J
.1. INSTITUTIONAL I.D.:
.J ...J\
4. INMATE NAME:.'
UU
2. STAFF 1.0.:
.
1/;1
tfOll.);)
17:);)
i ) -} '; ,-:'
/. -- \,../ / 0 0
5. S.B.1. #
~ 3. DATE OF CONTACT: ~
.--.....
/--:-\
to !.')JV
!
6. INMATE LOCATION:
••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
7. REASON FOR CONTACT:
11
12
13
14
15
16
17
18
19
20
21
22
99
llJ ·ILV I
.,
9. REFERRAL. COMPLETED TO:
(Check those Applicable)
Intake/Orientation
Administrative Referral
Classification Preparation
Formalized Counseling Session (Individual)
Routine Meeting
Inmate Request
Other Inmate
Correction Officer Referral
Community Agency Referral
Family Referral
Of her Institutional Staff Referral
Crisis Intervention
Other _ _ _ _ _ _ _ _ _ _ _ _ _ __
45 -- Classification Counselor
46 -- Classification Committee
47 -- Business Office
48 -- Psychologist/Psychiatrist
49 -- Work Release
50 -- EducationalNocational Program
51 -- Medical/Dental
'
52 -- Custody
53 -- Furlough Coordinator
54 -- Institutional Parole Officer
55 -- Parole Board Counselor
56 -- Outside Agency
57 -- Community Treatment Services
8. PROBLEM IDENTIFICATION (Check those Applicable) 58 -- Inmate Association
58--0ther ______________________________
19 -- Drug
~' 60 -- Referral Not Necessary
20 -- Alcohol
21 -- Homosexual Assault BehavIOr
22 -- Mental/Emotional
23 -- Administration
10. INDICATE WHICH SERVICE WAS PROVIDED:
24 -- Custody
(Check those Applicable)
25 -- Community Release
26 -- Parole
27,-- Furlough
6t -- Report Written
28 -- Death Bed/Funeral
( 621-- Information Provided
--63 -- Counseled Inmate
29 -- Work Reiease
64 -- Informal Communication
30 -- Medical
65 -- Other ______________________________
31 -- Family
'32 -- Adjustment Committee
33 -- Legal/Court
34 -- Business Office
11. INDICATE FUTURE SERVICE PLANS:
35 -- Claims
36 -- Mailroom
66 -- Follow-up with the inmate
37 -- Institutional Behavior Attitude
67 -- Follow-up of the Referral
38 -- Programming Opportunities
68--0ther ____________________
.. 39 -- Institutional Job Assignment
40 -- Institutional Housing Assignment
41 -- Institutional Time Discrepancy
42 -- Custody Status
..43\ -- None ('., (', :! (
(\ 44,I -- Other --':-.
\ -..,--'-':~----------. \ / .1
COMMENTS:
i
j,,,,
.
:
,-.A-I. · J /l ('
)'
'-~
\,.1'
...
(
\
:
' .. ,':'" I '
II
iJ
,'(I
•
I
I "
t /l-t 'L,A:..,....,
\
\, 1
'/'/"1
.....-1/J
.'
I
~). 1(;/11
I
\'
I
!
1=){"
17
)
I
./
I I
G-14
INMATE CONTACT FORM
iV J3\)
1. INSTITUTIONAL I.D.:
2.STAFFI.D.:
.
WW
UU
: 3. DATE OF: CONTACT:
1/'\1
LLJ
11 Intake/Orientation
12 Administrative Referral
45
46
47
48
-- Classification Counselor
-- Classification Committee
-- Business Office
-- Psychologist/Psychiatrist
49 -- Work Release
50 -- EducationalNocational Program
51 -- Medical/Dental
.
52 -- Custody
53 -- Furlough Coordinator
54 -- Institutional Parole Officer
55 -- Parole Board Counselor
56 -- Outside Agency
57 -- Community Treatment Services
8. PROBLEM IDENTIFICATION (Check those Applicable) 58 -- Inmate Association
58 -- Other _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___
19 -- Drug
/66'~- Referral Not Necessary
20 -- Alcohol
21 -- Homosexual Assault 8ellavior
22 -- Mental/Emotional
23 -- Administration
10. INDICATE WHICH SERVICE WAS PROVIDED:
24 -- Custody
(Check those Applicable)
25 -- Community Release
26 -- Parole
27·-- Furlough
,6j. -- Report Written
·62;-- Information Provided
28 -- Death Bed/Funeral
(6-3 -- Counseled rnmate
.29 -- Work Release
30 -- Medical
64 -- Informal Communication
65 -- Other _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
31 -- Family
'32 -- Adjustment Committee
33 -- Legal/Court
34 -- Business Office
35 -- Claims
11. INDICATE FUTURE SERVICE PLANS:
36 -- Mailroom
37 -- Institutional Behavior Attitude
66 -- Follow-up with the inmate
67 -- Follow-up of the Referral
38 -~ Programming Opportunities
68 -- Other
.
.. 39 -- Institutional Job Assignment
40 -- Institutional Housing Assignment
41 -- Institutional Time Discrepancy
42 -- Custody Status
43.-- None \ '. (. : I'
(44 ~~ Other ---'\-=-,,""..::::'~:....,'\.=.'}~~...:...:______________________
13 Classification Preparation
14 Formalized Counseling Session (Individual)
15 Routine Meeting
. 16 Inmate Request
17 Other Inmate
18 Correction Officer Referral
19 Community Agency Referral
20 . Family Referral
21 Of her Institutional Staff Referral
22 Crisis Intervention
99 Other ________________________________
Ik"-;...
COM~..
/ . . ) . ? / -)C
M ENTS :,--'i.'""/~i:_!'_,I.~::".;-::'.:_,+.'--;---'-,-~/.::".)~/~.:-!_..:../_,_
. . ..;....!-L-~L...-~-L-~';':"'"..!..c',LJ_',,!..,1..1..1~f_'~{.-'-.,.;:....:.
. . ·;c::..::;_I_--.:/~,,-I• .:...)_/_.J----r/L.:'_:;:../-=~~)
I I---.:.:..
I:.....,·fl....:·
,
, i,.
:
-t .r
J. •• ~
..
J'
••
"
,i
~
I
,;
.'
j'
\
,:'
1
!
i)
=f--;V.
I~
·-_l!..../. . .j->
'
:::
r
if')
...Li...:..i._'_ _
,i / ',.
'~
'( I
'f
,<
I" •
.i
M
.f'
'
f
;/";
"" /,~ \ l~
1."l
//
INMATE CONTACT FORM
G-14
4. INMATE NAME:
1. INSTITUTIONAL 1.0.:
r-)
.l(.
Tn. i )(')
~ ''I Wi I
·D\ \ h')/I . .D,A..-'V'"
I
I
UU
101
2. STAFF 1.0.:
LJLJ
5. S.B.!. #
n;;}J073B
_--!-_ _ _...:..-_ _ _ _ _ __
6. INMATE LOCATION:
: 3. DATE OF CONTACT:
/\ - ~II
Lj M../
••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
7. REASON FOR CONTACT:
11
12
13
14
15
16
17
18
19
20
21
22
99
LlJ
,I
\.y 1
.
.
9. REFERRAL COMPLETED TO:
(Check those Applicable)
Intake/Orientation
Administrative Referral
Classification Preparation
Formalized Counseling Session (Individual)
Routine Meeting
Inmate Request
Other Inmate
Correction Officer Referral
Community Agency Referral
Family Referral
Other Institutional Staff Referral
Crisis Interv'ention
Other ____________________________
45 -- Classification Counselor
46 -- Classification Committee
47 -- Business Office
48 -- Psychologist/Psychiatrist
49 -- Work Release
50 -- EducationalNocational Program
51 -- Medical/Dental
.
52 -- Custody
53 -- Furlough Coordinator
54 -- Institutional Parole Officer
55 -- Parole Board Counselor
56 -- Outside Agency
57 -- Community Treatment Services
8. PROBLEM IDENTIFICATION (Check those Applicable) 58 -- Inmate Association
5 -- Other _____________________
19--Drug
~60 -- Referral Not Necessary
20 -- Alcohol
21 -- Homosexual Assau t e aVlor
22 -- Mental/Emotional
23 -- Administration
1Q. !ND!GATE WH!GH SERV!GE WAS PROY!DED:
24 -- Custody
(Check those Applicable)
25 -- Community Release
26 -- Parole
27,-- Furlough
~ -- Report Written
"fg)-- Information Provided
28 -- Death Bed/Funeral
63 -- Counseled Inmate
.29 -- Work Release
64 -- Informal Communication
30 -- Medical
65--0ther _________________________________
31 -- Family
'32 -- Adjustment Committee
33 -- Legal/Court
34 -- Business Office
11. INDICATE FUTURE SERVICE PLANS:
35 -- Claims
36 -- Mailroom
66 -- Follow-up with the inmate
37 -- Institutional Behavior Attitude
67 -- Follow-up of the Referral
38 -- Programming Opportunities
68
-- Other _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
39 -- Institutional Job Assignment
40 -- Institutional Housing Assignment
41 -- Institutional Time Discrepancy
42 -- Custody Status
(!~f
d-
None\
Other
/, -[
~'_
I,J./.;
/,!
"'"--<.! l.\. .~' 7(J(C {. ~ :),1 'to J
:r'~
COM.
MENTS:
f,
,_
Ij(/{f
. {'1k
.
V,',' /" / . J
'
l~ll l f, ,,{/
/
,!
"
I
/1_UU})h.J t ;.:,
i,.
/
\i;i?
,- -
....,
_.'
I
/! LV! i.(·{·1
()
W LJ
INMATE CONTACT FORM
G-14
.1. INSTITUTIONAL 1.0.:
2. STAFF 1.0.:
f\),}.~()
.~
4. INMATE NAME:
, ~'T~
0,"
h-)bp\/
jJ) i
(););)C'')0] .0\
UU
/
5. S.B.1. # __' /<----'-~_J._...J.....:=.~_,o--'lC-.-.._ _ _ __
Lj A-3./
lllJ
................
..,............................................... .
UJ ·Il 0 I
.
.
\ 3. DATE OF CONTACT:
llr\\ I
6. INMATE LOCATION:
7. REASON FOR CONTACT:
9. REFERRAL COMPLETED TO:
(Check those Applicable)
.
i.
11
12
13
14
15
16
17
18
19
20
21
22
99
Intake/Orientation
Administrative Referral
Classification Preparation
Formalized Counseling Session (Individual)
Routine Meeting
Inmate Request
Other Inmate
Correction Officer Referral
Community Agency Referral
Family Referral
Other Institutional Staff Referral
Crisis InterJention
Other
'
45 -- Classification Counselor
46 -- Classification Committee
47 -- Business Office
48 -- Psychologist/Psychiatrist
49 -- Work Release
50 -- EducationalNocational Program
51 -- Medical/Dental
.
52 -- Custody
53 -- Furlough Coordinator
54 -- Institutional Parole Officer
55 -- Parole Board Counselor
56 -- Outside Agency
57 -- Community Treatment Services
58 -- Inmate Association
58--0ther _______________________
8. PROBLEM IDENTIFICATION (Check those Applicable)
19--Drug
/'6i):} Referral Not Necessary
20 -- Alcohol
21 -- Homosexual Assault Behavior
22 -- Mental/Emotional
23 -- Administration
10. !NDlCATE WHICH SERVICE WAS PROV!DED:
24 -- Custody
. (Check those Applicable)
25 -- Community Release
26 -- Parole
.6-:l -- Report Written
27·-- Furlough
{6~ -- Informt'ltion Provided
28 -- Death Bed/Funeral
'-63 -- Counseled Inmate
29 -- Work Release
64 -- Informal Communication
30 -- Medical
65--0ther _________________________
31 -- Family
'32 -- Adjustment Committee
33 -- Legal/Court
34 -- Business Office
'. 35 -- Claims
11. INDICATE FUTURE SERVICE PLANS:
36 -- Mailroom
66 -- Follow-up with the inmate
37 -- Institutional Behavior Attitude
67 -- Follow-up of the Referral
38 -- Programming Opportunities
68--0ther ________________________
39 -- Institutionai job Assignment
40 -- Institutional Housing Assignment
41 -- Institutional Time Discrepancy
42 -- CustodY"''itatl,!,S
,.A3 -- None :/ : i If"ll (ill}
Other -",-I_/;_\_./_u~,_~V--,-l~V::::..L..I _ _ _ _ _ __
ff
(j_
eOMMENTS: _ _~~~~----------_,~~---~r__+--------~~-----------------
\ '\ \'
'<',,- \
.II
/ v
'i( ::i \'1
I/U:-' U''1\
/
I
()
/
'--j( LLL-Ljp
I
,

