California Code of Regulations › Title 2 - Administration › Division 7 - Secretary of State › Chapter 11 - Safe at Home Confidential Address Program › Section 22100.2 - Program Participant Application and Fees Under Chapter 3.2 (Commencing with Section 6215) of Division 7 of Title 1 of the Government Code

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) To apply to
				become a program participant a reproductive health care services facility,
				provider, employee, volunteer, patient, or family member of a reproductive
				health care services provider, employee, volunteer, or patient who is a program
				participant shall submit a completed Safe at Home Application & Checklist
				Form, revised September 29, 2003, in accordance with Section
				6215.2 of
				the Government Code. The application fee for a reproductive health care
				services facility, provider, employee, volunteer, or family member of a
				reproductive health care services provider, employee, or volunteer who is a
				program participant is thirty dollars ($30). The application fee is
				nonrefundable. Reproductive health care services patients and family members of
				reproductive health care services patients who are program participants shall
				not be charged an application fee.
(b) In addition to the requirements contained
				in Section
				6215.2 of
				the Government Code, the Safe at Home Application & Checklist Form, revised
				September 29, 2003, shall include a notice that a person who willfully
				certifies as true any material matter pursuant to Section
				6215.2 of
				the Government Code which he or she knows to be false is guilty of a
				misdemeanor and shall require all of the following:
(1) Applicant's first, middle, and last name,
				date of birth, age, marital status, and sex;
(2) Whether the program participant can sign
				for and accept legal documents at his or her residence or mailing address;
				and
(3) Agree to all of the
				following provisions.
(A) Safe at Home is a
				mail forwarding service only. A program participant's mail will first be
				received at the Secretary of State Safe at Home address in Sacramento before it
				is forwarded to a program participant's address. This will result in a two to
				three day delay in receiving mail.
(B) Magazines, packages, catalogs, junk mail
				or any mail that is not first-class, except mail from governmental agencies,
				will not be forwarded to a program participant's address.
(C) Mail may not be forwarded to a program
				participant if it is sent to a name other than the name listed on the
				application form.
(D) Completing an
				application form using a name other than the program participant's legal name
				could result in the denial of program privileges at certain agencies if a legal
				name is required to access their services.
(E) All state and local government agencies
				must accept a Safe at Home address. Private companies, such as insurance,
				telephone, and utility, are not obligated to use a program participant's Safe
				at Home address and may require an actual residential street address.
(F) If the program participant is a United
				States citizen, the program participant may become a Confidential Voter by
				filling out the Confidential Affidavit of Registration and Absentee Ballot
				Application provided with the program participant application. Once a program
				participant is registered, he or she shall receive an Absentee Ballot to vote
				by mail in future elections.
(G) If
				the program participant purchases property using his or her own name, the
				property address location will be listed on the legal description filed with
				the county assessor's office and available for public inspection upon
				request.
(H) If the program
				participant purposefully or accidentally gives his or her actual residence
				address to an agency, that agency is not required to keep that address
				confidential and is not responsible for its
				release.