2021/2022 Priorities Survey - Client Please take a few minutes to answer some questions about legal problems you might have. This survey will help Legal Aid decide what kinds of cases to take. For some questions you may choose more than one answer. Thank you for your help. OK Question Title * 1. What Tennessee county do you live in? Anderson Bedford Campbell Cannon Cheatham Claiborne Clay Coffee Cumberland Davidson DeKalb Dickson Fentress Franklin Giles Grundy Hickman Houston Humphreys Jackson Lawrence Lewis Lincoln Macon Marshall Maury Montgomery Moore Morgan Overton Perry Pickett Putnam Roane Robertson Rutherford Scott Smith Stewart Sumner Trousdale Union Van Buren Warren Wayne White Williamson Wilson Other (please write below) OK Question Title * 2. Please check all that apply. I am disabled. I have someone in my home who does not speak English well. My income is low. I need a job. I have people over age 60 in my home. I have children under 18 in my home. I am a veteran. I am retired. I came to the U.S. from another county. I have gotten help from Legal Aid. I am age 60 or older Other (please write below) OK Question Title * 3. Please check one. I own my own home. I live in public or Section 8 housing. I live in a place where I pay the whole rent. I live with others and pay my own way. I live with others and do not pay rent and/or my own way. I am homeless. I pay rent OK Question Title * 4. During the past year has anyone in your household had legal problems with (OK to check more than one) Getting a doctor's services? Getting or paying for medicine? Private health insurance? Medicare? Paying medical bills? TennCare? Getting home health care? Getting hospital services? Getting nursing home care? Getting mental health services? Other health problem? (please write below) OK Question Title * 5. During the past year has anyone in your household had legal problems with (OK to check more than one) Adoption? Family violence / spouse abuse / other abuse my someone you know? Name change? Grandparents' rights? Getting child support? Guardianship of a child or conservatorship for an adult who can't make decisions for themself? Getting a divorce or separation? Juvenile court? Child custody or visitation? Divorce Other family problem? (please write below) OK Question Title * 6. During the past year has anyone in your household had legal problems with (OK to check more than one) Unfair credit? Collecting money owed to you? Bills you can't pay? Identity theft? Getting ripped off? Check advance or title loan company? Something wrong on your credit report? Getting credit? Bankruptcy? Bill collectors? Other money problem? (please write below) OK Question Title * 7. During the past year has anyone in your household had legal problems with (OK to check more than one) Having utilities cut off by landlord? Public or Section 8 housing? Unfair credit? Foreclosure? Private landlord? Making mortgage payments? Unsafe or unhealthy rental property? Being evicted or locked out without going to court? Other housing problem? (please write below) OK Question Title * 8. During the past year has anyone in your household had legal problems with (OK to check more than one) Supplemental Security Income (SSI)? Social Security Disability benefits (SSDI)? SNAP or Food Stamps? Wage claims Social Security Retirement benefits? Workers' Comp? Veterans' benefits? Income tax Unemployment benefits? Other public benefits problem? (please write below) OK Question Title * 9. During the past year has anyone in your household had legal problems with (OK to check more than one) Wills? Income taxes? Immigration? Paying public school fees for supplies or field trips? Cleaning up criminal record? Court costs? Special education? School discipline? Driver's or other license? Any other problem not listed? (please write below) OK DONE