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