LAS 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 retired. I came to the U.S. from another county. I have children under 18 in my home. I have someone in my home who does not speak English well. I have gotten help from Legal Aid. I need a job. I am a veteran. My income is low. I am disabled. I have people over age 60 in my home. 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 hospital services? Getting home health care? Getting or paying for medicine? Medicare? Paying medical bills? Getting a doctor's services? Getting nursing home care? TennCare? Private health insurance? 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) Divorce Getting child support? Family violence / spouse abuse / other abuse my someone you know? Grandparents' rights? 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? Name change? Adoption? 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) Identity theft? Collecting money owed to you? Bills you can't pay? Something wrong on your credit report? Unfair credit? Bill collectors? Getting ripped off? Bankruptcy? Check advance or title loan company? Getting credit? 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) Unsafe or unhealthy rental property? Public or Section 8 housing? Being evicted or locked out without going to court? Having utilities cut off by landlord? Unfair credit? Private landlord? Making mortgage payments? Foreclosure? 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) Income tax Workers' Comp? Unemployment benefits? Wage claims Supplemental Security Income (SSI)? Veterans' benefits? Social Security Disability benefits (SSDI)? Social Security Retirement benefits? SNAP or Food Stamps? 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) Driver's or other license? Paying public school fees for supplies or field trips? Wills? Special education? Immigration? Income taxes? Court costs? School discipline? Cleaning up criminal record? Any other problem not listed? (please write below) OK DONE