Cal. Code Regs. Tit. 2, § 22100.2 - Program Participant Application and Fees

Current through Register 2022 Notice Reg. No. 14, April 8, 2022

(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.
(c) Within ten (10) business days of the Secretary of State actually receiving the Safe at Home Application & Checklist Form the Secretary of State shall mail a notice to the applicant stating whether or not he or she has been certified as a program participant.
(d) All information submitted by an applicant is confidential and shall be treated as such by enrolling agencies. Enrolling agencies shall forward all Safe at Home Applications & Checklist Forms and all attachments thereto to the Secretary of State within twenty-four (24) hours of receipt of a completed enrollment package. Enrolling agencies shall not copy, store, or maintain any of the information provided by an applicant as part of the Safe at Home Confidential Address Program, including, but not limited to, applications, attachments, supporting documentation, notes, letters, payment information, and information therein.
(e) Enrolling agencies shall not charge any individual for counseling, application and orientation material, assistance in completing the application, forwarding the application to the Secretary of State, or any other services relating to Safe at Home.
(f) The annual fee for reproductive health care services facilities, providers, employees, and volunteers who are health care professionals is seventy-five dollars ($75). The annual fee is nonrefundable. The annual fee must be received by the Secretary of State no later than five (5) business days after the anniversary date of becoming a program participant. If the annual fee is received by the Secretary of State later than five (5) business days after the anniversary date of becoming a program participant, certification as a program participant shall be terminated in accordance with Section 22100.4. Reproductive health care services patients and family members of reproductive health care services patients who are program participants shall not be charged an annual fee.

Notes

Cal. Code Regs. Tit. 2, § 22100.2

Note: Authority cited: Section 6215.9, Government Code. Reference: Section 2166.5, Elections Code; and Sections 6215.2, 6215.5, 6215.6 and 6215.8, Government Code.Authority cited: Section 6215.9, Government Code. Reference: Section 2166.5, Elections Code; and Sections 6215.2, 6215.5, 6215.6 and 6215.8, Government Code.

1. Certificate of Compliance as to 12-1-2003 order, including renumbering of former section 22110 to new section 22100.2 and amendment of section heading, section and Note, transmitted to OAL 3-29-2004 and filed 5-11-2004 (Register 2004, No. 20).

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