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 age 60 or older I came to the U.S. from another county. I am retired. I am disabled. My income is low. I need a job. I have children under 18 in my home. I have someone in my home who does not speak English well. I am a veteran. I have people over age 60 in my home. I have gotten help from Legal Aid. 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) Medicare? Private health insurance? Getting or paying for medicine? Getting mental health services? TennCare? Getting hospital services? Getting home health care? Paying medical bills? Getting a doctor's services? Getting nursing home care? 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) Family violence / spouse abuse / other abuse my someone you know? Name change? Child custody or visitation? Getting child support? Adoption? Divorce Grandparents' rights? Guardianship of a child or conservatorship for an adult who can't make decisions for themself? Juvenile court? Getting a divorce or separation? 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) Getting ripped off? Bill collectors? Identity theft? Bills you can't pay? Getting credit? Collecting money owed to you? Check advance or title loan company? Bankruptcy? Unfair credit? Something wrong on your credit report? 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) Foreclosure? Unsafe or unhealthy rental property? Having utilities cut off by landlord? Private landlord? Unfair credit? Public or Section 8 housing? Making mortgage payments? 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) Veterans' benefits? Workers' Comp? SNAP or Food Stamps? Unemployment benefits? Social Security Disability benefits (SSDI)? Wage claims Social Security Retirement benefits? Supplemental Security Income (SSI)? Income tax 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) School discipline? Cleaning up criminal record? Wills? Court costs? Income taxes? Immigration? Special education? Driver's or other license? Paying public school fees for supplies or field trips? Any other problem not listed? (please write below) OK DONE