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