2023/2024 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 retired. I am age 60 or older I am disabled. I am a veteran. I have children under 18 in my home. I have people over age 60 in my home. I need a job. My income is low. I came to the U.S. from another county. I have someone in my home who does not speak English well. 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) Private health insurance? Getting nursing home care? Getting hospital services? Getting mental health services? Medicare? Getting home health care? Paying medical bills? Getting a doctor's services? TennCare? Getting or paying for medicine? 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) Guardianship of a child or conservatorship for an adult who can't make decisions for themself? Child custody or visitation? Divorce Family violence / spouse abuse / other abuse my someone you know? Adoption? Grandparents' rights? Getting child support? Juvenile court? Name change? Getting a divorce or separation? 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? Collecting money owed to you? Getting ripped off? Check advance or title loan company? Something wrong on your credit report? Bills you can't pay? Unfair credit? Identity theft? Bill collectors? Getting credit? 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? Having utilities cut off by landlord? Public or Section 8 housing? Private landlord? Unsafe or unhealthy rental property? Foreclosure? Being evicted or locked out without going to court? Unfair credit? 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) Veterans' benefits? Income tax Social Security Retirement benefits? SNAP or Food Stamps? Social Security Disability benefits (SSDI)? Workers' Comp? Wage claims Unemployment benefits? Supplemental Security Income (SSI)? 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) School discipline? Cleaning up criminal record? Income taxes? Driver's or other license? Court costs? Paying public school fees for supplies or field trips? Immigration? Special education? Wills? Any other problem not listed? (please write below) OK DONE