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