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