2023/2024 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. My income is low. I came to the U.S. from another county. I have someone in my home who does not speak English well. I have gotten help from Legal Aid. I am retired. I have children under 18 in my home. I have people over age 60 in my home. I am disabled. I am age 60 or older I need a job. I am a veteran. 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) TennCare? Getting nursing home care? Getting mental health services? Getting home health care? Paying medical bills? Getting or paying for medicine? Medicare? Getting a doctor's services? Getting hospital services? Private health insurance? 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) Juvenile court? Family violence / spouse abuse / other abuse my someone you know? Grandparents' rights? Child custody or visitation? Adoption? Getting a divorce or separation? Getting child support? Divorce Name change? Guardianship of a child or conservatorship for an adult who can't make decisions for themself? 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 credit? Bill collectors? Check advance or title loan company? Unfair credit? Collecting money owed to you? Bankruptcy? Bills you can't pay? Something wrong on your credit report? Getting ripped off? Identity theft? 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) Making mortgage payments? Public or Section 8 housing? Being evicted or locked out without going to court? Having utilities cut off by landlord? Unfair credit? Unsafe or unhealthy rental property? Foreclosure? Private landlord? 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) Social Security Disability benefits (SSDI)? Workers' Comp? Wage claims Veterans' benefits? Supplemental Security Income (SSI)? Unemployment benefits? SNAP or Food Stamps? Social Security Retirement benefits? 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) Driver's or other license? Cleaning up criminal record? Income taxes? Immigration? School discipline? Court costs? Wills? Special education? Paying public school fees for supplies or field trips? Any other problem not listed? (please write below) OK DONE