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