WHAT QUESTIONNAIRE SHOULD I USE?

WHICH QUESTIONNAIRE DO I USE?

This list is to help figure out what questionnaire to use in addition to the eligibility form. If applicant=s legal problem is not listed, use Additional Information Questionnaire.

Problem / Questionnaire
Abuse : Spousal/domestic / Domestic Violence
Accidents: Car Accident / Car Accident
Accidents: Other / See Staff
Adoption / Adoption
Alimony (Maintenance)
Needs order / Domestic +Dissolution of Marriage
Enforce or Modify Existing Order / Domestic +Post-Decree
Aid to the Needy Disabled / AND
Denial, Termination, Reduction, or Overpayment / AND
Annulment / Decleration of Invalidity / Domestic + Dissolution of Marriage
Automobile / Car
Accident / Car Accident
Repair / Consumer Goods and Services
Repossession / Collection + Reposession Supp
Bankruptcy
Applicant owns home / Bankruptcy / foreclosure
Applicant does not own home / Bankruptcy
Bad or Bounced Check / Collection
Bank Account Garnished / Attached / Collection
Garnished for Child Support Debt / Child Support - noncustodial
Back Rent or Damages Collection / Collection
Belongings Held by Landlord / Eviction + Lockout
Belongings Held by Someone other than Landlord / Additional Information
Bench Warrant (Failure to Answer Interrogatories) / Collection
Bills, Collection / Collection
Debt other than Public Benefit Overpayment / Collection
Car
Accident / Car Accident
Repossession / Collection + Reposession Supplement
Repairs / Consumer Goods and Services
Title Dispute / Consumer Goods and Services
Child Care Benefits (through TANF) / Child Care
If Married / Domestic Questionnaire

[Type text]

Child Support
If Married / Dissolution of Marriage
If Not Married / Custody
Need Child Support Order / Domestic
Need Collect / Enforce Current Order / Domestic + Post-Decree
Need Modify Existing Order / Domestic + Post-Decree
Someone Trying to Collect From Applicant / Domestic + Post-Decree
Agency won't collect Child Support / Child Support Enforcement
Collection of Debt / Collection
Consumer Debt / Collection
Repo Deficiency / Collection + Repossession Supp
Medical Debt / Collection + Medical Debt Supp
Garnishment, attachment / Collection
Mortgage / Bankruptcy / foreclosure
Overpayment of Public Benefits / Overpayment
Common Law Marriage / Domestic +
Do I have one? / Common Law Marriage
Ending Common Law Marriage / Common Law Marriage + DOM
Complaints - Consumer
Repairs, services, purchases unsatisfactory / Consumer Goods and Services
Conditions / Repairs of Rental Residence / Conditions
Conservatorship
Get over incompetent Person / Guardianship/Conservatorship(Initiate)
Contest Action (by protected person) / Guardianship/Conservatorship(Contest)
Consumer Problems
Debt Owed by Applicant / Collection
Complaint about Product or Service / Consumer Goods and Services
Criminal
Seal Criminal Record / Sealing a Criminal Record
Any Other Criminal Matter / Do not interview.
Custody
Obtain Custody / Domestic + Allocation of Parental Resp.
If Married to Other parent / Domestic + Dissolution of Marriage
Defend or Respond to Case
Change / Modify Existing Order / Domestic + Post Decree, APR
Child Taken by Social Services / Do not interview.
Damage to Previous Apartment / Collection
Damages - Want to Sue for Injuries / See Staff
Day Care Benefits (Denial or Termination) / Child Care

[Type text]

Debt
Consumer Debt (Bounced Check, Credit Card) / Collection
Repo Deficiency / Collection + Reposession Supp
Medical Debt / Collection + Medical Debt Supp
Garnishment, attachment / Collection
Overpayment of Public Benefits / Overpayment
Declaration of Invalidity / Domestic + Dissolution of Marriage
Deed (real property)
Transfer, quit claim, clear up title / Real Property Title Dispute
If other owner is ex-spouse / Post-Decree
If after death of owner now in estate / Probate + Real Property Title Dispute
Deposit - Return of Security Deposit / Security Deposit
Denial of State Identification / Denial of Identification
Disability
Denied or Terminated Social Security Benefits / Social Security / SSI
Denied or Terminated Private Employment / Additional Information
Dissolution of Marriage
Wants to File / Domestic + Dissolution of Marriage
If Children / & Allocation of Parental Responsibility
Already Filed but Not Complete / Domestic+DOM+Family Law Litigation
If Children / & Allocation of Parental Responsibility
Completed (Enforce or Modify) / Domestic + Post Decree
Domestic Violence (TPO/PPO) / Domestic Violence
Employment
Fired, wrongful termination, discrimination / Do not interview.
Back Wages / Additional Information
Unemployment Benefits / Unemployment
Estate Planning
Will / Will
Power of Attorney / Power of Attorney
Eviction / Eviction
Excel Utility Shutoff / Utility Shutoff + LEAP
Expunge Criminal Record / Sealing a Criminal Record
Financial Exploitation - Senior / Additional Information
Food Stamps (Denial, Reduction, or Termination) / Food Stamps
Foreclosure / Bankruptcy / foreclosure
Fraud
Consumer Fraud/Scam / Consumer Goods and Services
TANF (Welfare Fraud) / TANF
Food Stamps / Food Stamps

[Type text]

Garnishment
Wage or Bank Account - Consumer Debt / Collection
Child Support Collection / Domestic + Post-Decree
Grandparent Visitation or Rights / Domestic + Allocation of Parental Resp.
If Case Filed / & Family Law Litigation + Post-Decree
Guardianship
Initiate Guardianship over Incompetent Person / Guardianship/Conservatorship Initiate
Contest Action (by protected person) / Guardianship/Conservatorship Contest
Child / Allocation of Parental Responsibility
Harrassment
By Family Member of boy/girlfriend / Domestic Violence
By Creditor / Collection
By Landlord or Apartment Manager / Landlord/Tenant (Other)
Home Care
Home Care Allowance Denial / Home Care
Home and Community Based Services Denial / Home Care
Home Owners Association Fees / Foreclosure + Bankruptcy
Housing
Eviction / Eviction
Condition of Premises / Housing Conditions + Landlord / Tenant
Subsidy Denied / Subsidized Housing Denial
Section 8 Voucher Terminated / Section 8 Voucher Termination
Prior Landlord Collecting Back Rent / Collection
Deposit Not Returned / Security Deposit
ID
Can't get Drivers License / Denial of Identification
Identity Theft / Identity Theft
Injuries - Car Accident / Car Accident
Insurance / Consumer Goods and Services
Interrogatories for Collection of Judgment / Collection
Low Income Energy Assistance (LEAP) / LEAP + Utility Shutoff
Landlord Problems
Eviction / Lockout / Eviction
Conditions / Conditions
Collection of Back Rent or Damages / Collection
Deposit - Return of Security Deposit / Security Deposit
Lease Dispute / Landlord/Tenant (Other)
Legal Separation
Wants to Get One / Domestic + Dissolution of Marriage
Needs to Respond to One / Domestic+DOM+Family Law Litigation
Lien / Collection + Foreclosure
Living Will / Power of Attorney
Lockout / Eviction + Lockout
Maintenance (Alimony)
Wants to Get Order / Domestic + Dissolution of Marriage
Wants to Enforce or Modify Order / Domestic + Post-Decree
Wants to Defend Against Other Side / Domestic + Post-Decree
Medicaid
Denial, Termination, Eligibility / Medicaid Termination or Denial
Long Term Care Denial or Termination / Home Care
Medicaid Refuses to Pay for Treatment / Medicaid Coverage Denial
Medical Debt / Collection + Medical Debt Supp
Medicare
Denial, Termination, Eligibility / Medicare Termination or Denial
Premiums / Medicare Termination or Denial
Denied Reimbursement for Procedure / Medicare Denial of Coverage
Mortgage / Foreclosure + Bankruptcy
Nursing Home
Denial or Termination of Medicare Coverage / Medicare Termination or Denial
Complaints: Re: Treatments or Conditions / Additional Information
Old Age Pension / OAP
Overpayment of Public Benefits / Overpayment
Paternity / See Staff
Permanent Restraining Order / Domestic Violence
Power of Attorney / Power of Attorney
Post Decree Domestic (After Judgement)
Change or Enforce Custody / Domestic + Post-Decree + APR
Change Child Support
Applicant Has Child / Domestic + Child Support (custodial)
Other Parent Has Child / Domestic+Child Support (non-custodial)
Change Maintenance / Domestic + Post-Decree
Change Visitation / Domestic + Post-Decree + APR
Enforce Child Support / Domestic + Child Support (custodial)
Probate
Someone Has Died / Probate
Applicant Needs a Will / Will
Property
Real Estate Title Dispute or Quit Claim Deed / Real Property Title Dispute
Foreclosure / Foreclosure + Bankruptcy
Personal Property
Held by Landlord / Landlord/Tenant (Other)
Held by Someone Else / Additional Information
Protection Order / Domestic Violence
Quit Claim Deed / Real Property Title Dispute
Repairs
To car, house, goods / Consumer Goods and Services
To rented apartment or house / Landlord/Tenant (Other)
Repossession / Collection + Reposession Supp
Restraining Order / Domestic Violence
Sale
Real Property / Real Property Title Dispute
Other / Consumer Goods and Services
Seal Criminal Record / Sealing a Criminal Record
Section 8
Denial / Subsidized Housing Denial
Termination / Section 8 Voucher Termination
Security Deposit / Security Deposit
Utility Shutoff / Utility Shutoff + LEAP
Small Claims Court
Plaintiff (filing suit) / Additional Information
Defendant (being sued - responding) / Collection
Social Security (Disability or Retirement Denial) / Social Security / SSI
Social Services
TANF Denial, Termination, or Reduction / TANF
OAP Denial, Termination, or Reduction / OAP
Food Stamps Denial, Termination, or Reduction / Food Stamps
HCBS or HCA Denial or Reduction / Home Care
Subsidy (housing)
Denied / Subsidized Housing Denial
Cancelled / Termination of Section 8 / Section 8 Voucher Termination
Cancelled / Termination not Section 8 / Subsidized Housing Denial
Supplemental Security Income (SSI)
Denial, Termination, or Reduction / Social Security / SSI
Overpayment / Overpayment
Spouse Abuse / Violence Protection / Domestic Violence
Student Loans / Collection

[Type text]

Subsidized Housing
Eviction / Eviction
Denial / Subsidized Housing Denial
Cancellation / Subsidized Housing Denial
Conditions / Conditions + Landlord/Tenant-other
Security Deposit / Security Deposit
TANF / TANF
Tax
Income Tax / Collection
Real Property Taxes / Collection + Bankruptcy + Foreclosure
Temporary Protection Order / Domestic Violence
Temporary Restraining Order / Domestic Violence
Title
To House / Real Property Title Dispute
To Car / Consumer Goods and Services
Trust
Testamentary Trust-Applicant / Will
Testamentary Trust of Person / Probate
Unemployment Benefits (Denial, termination, reduction) / Unemployment
Utility Shutoff / Utility Shutoff + LEAP
Visitation
Needs to Establish / Domestic + APR + DOM
Needs to Modify / Enforce / Domestic + Post-Decree
Warranty / Consumer Goods and Services
Welfare (TANF, OAP, SSI, Food Stamps) / Applicable to problem / public benefits-other
Wills
Applicant Wants a Will / Will
Contest a Will / Probate

S:\intake\Volunteer Info\WHAT QUESTIONNAIRE.docx12/18/2013