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