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