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