2020/2021 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 need a job. My income is low. I am disabled. I am a veteran. I have children under 18 in my home. I am retired. I have someone in my home who does not speak English well. I have gotten help from Legal Aid. I have people over age 60 in my home. I came to the U.S. from another county. 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 home health care? Getting mental health services? Paying medical bills? Getting a doctor's services? Private health insurance? Getting nursing home care? Getting hospital services? Medicare? Getting or paying for medicine? TennCare? 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) Name change? Guardianship of a child or conservatorship for an adult who can't make decisions for themself? Family violence / spouse abuse / other abuse my someone you know? Divorce Grandparents' rights? Child custody or visitation? Getting a divorce or separation? Adoption? Juvenile court? Getting child support? 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) Collecting money owed to you? Bills you can't pay? Bankruptcy? Check advance or title loan company? Unfair credit? Getting ripped off? Something wrong on your credit report? Bill collectors? Identity theft? 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? Being evicted or locked out without going to court? Foreclosure? Public or Section 8 housing? Unfair credit? Private landlord? Having utilities cut off by landlord? Making mortgage payments? 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 Retirement benefits? Unemployment benefits? SNAP or Food Stamps? Social Security Disability benefits (SSDI)? Wage claims Veterans' benefits? Workers' Comp? 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) Driver's or other license? School discipline? Cleaning up criminal record? Special education? Paying public school fees for supplies or field trips? Wills? Court costs? Income taxes? Immigration? Any other problem not listed? (please write below) OK DONE