Legal Needs Survey for Community Members
You can help us make our services better.  We want to know what issues community members are seeing so that we can better address those needs. We would greatly appreciate if you could complete the following survey. It should take under 15 minutes to complete.

If you or a member of your household has not been affected by an issue in the last three years, you can just leave the row blank.

If you have any questions, please email survey@lawny.org.
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Employment Issues:  Check how many times this issue has happened to you or a household member in the past 3 years:
1-2
3-4
5 or more
Loss of or difficulty finding a job
Problems finding or paying for childcare
Lack of affordable transportsation
Denial of unemployment benefits
Problems or delays in applying online or by phone for unemployment benefits, including additional pandemic-related federal unemployment benefits
Problems receiving unemployment benefits (including over-payment issues)
Employment Discrimination
Problems getting paid (including for overtime)
Problems with a pension
Problems starting a small business
Problems with a job training program
Denied employment due to a criminal record
Clear selection
Housing Issues:  Check how many times this issue has happened to you or a household member in the past 3 years:
1-2
3-4
5 or more
Homelessness
Bad housing conditions (other than lead paint)
Lead paint problems
Problems with code enforcement response to complaints
Problem with law enforcement's response to housing complaints
No access to public or subsidized housing
Discrimination in renting
Discrimination in home purchases
Eviction
Fell behind in rent
Need for special housing for persons with disabilities
Mobile home problems
Foreclosure of home/farm
Land contract/rent-to-own problems
Landlord in foreclosure
Denied housing due to a criminal record
Loss or threatened loss of housing due to Covid-19
Clear selection
Education Issues:  Check how many times this issue has happened to you or a household member in the past 3 years:
1-2
3-4
5 or more
Problems with reading and writing skills
Problems with getting GED
Problems with school suspension/discipline
Student loan debt problems
Problems getting access to job training programs
School violence
Need for special education
Problems getting access to school (e.g. residency issues, need for language services)
Problems with accessing education due to Covid-19
Clear selection
Family Issues:  Check how many times this issue has happened to you or a household member in the past 3 years:
1-2
3-4
5 or more
Experienced Intimate Partner Violence (domestic violence)
Experienced sexual assault
Was charged with child abuse or neglect in Family Court
Experienced loss of visitation/custody due to substance abuse issues
Need for child custody or visitation petition/order
Need to file for child support OR increase support
Need to lower child support
Had a child support violation filed in Family Court
Need to file for spousal support
Need to establish paternity
Child in foster care
Child in need of special placement
Got divorced OR wanted to but was unable to
Completed an adoption OR wanted to but was unable to
Changed name OR wanted to change name but was unable to
Obtained Guardianship OR wanted to but was unable to
Lost time with child(ren) due to COVID related issues
Got behind in child support due to COVID related issues
Clear selection
Healthcare Issues:  Check how many times this issue has happened to you or a household member in the past 3 years:
1-2
3-4
5 or more
Problems getting treatment for serious physical illness or disability
Problems getting treatment for mental illness
Problems getting drug and/or alcohol disorder treatment
Problems getting medical care
Lack/loss of health insurance
Inability to afford health insurance premium
Lack/loss of prescription drug coverage
Inability to afford prescriptions
Problems getting durable medical equipment
Problems with nursing home
Denial of insurance coverage (i.e. bill denial, prior authorization denial)
Problems getting dental care
Problems with homecare
Problems with Medicaid (including Medicaid spend down)
Problems with Medicare
Problems with Child Health Plus
Problems with Essential Plan
Problems with private health insurance
Problems with nursing home debt
Problems with health insurance or access to healthcare due to Covid-19
Clear selection
Government Benefits Issues: Check how many times this issue has happened to you or a household member in the past 3 years:
1-2
3-4
5 or more
Denial/loss/reduction of public assistance
Denial/loss/reduction of social security disability or SSI benefits
Denial/loss/reduction of food stamps/SNAP
Denial of emergency services (e.g. for food, housing or medicine)
Denial/loss/reduction of veterans benefits
Denial/loss/reduction of child care subsidy
Problems with accessing benefits due to Covid-19
Clear selection
Consumer Issues:  Check how many times this issue has happened to you or a household member in the past 3 years:
1-2
3-4
5 or more
Repossession of car
Filed or needed to file for bankruptcy
Problems with creditors
Inability to obtain loans or credit at reasonable interest rates
Unpaid utility bills (electricity, gas, phone, water)
Problems with a “Rent to Own” home.
Home improvement loan debt
Garnishment of wages
Problems with identity theft
Problems with credit reports
Problems with contractors
Been a victim of a scam
Been a victim of a Covid-19 related scam
Clear selection
Other Issues: Check how many times this issue has happened to you or a household member in the past 3 years:
1-2
3-4
5 or more
Loss of driver's license
Victim of crime
Needed someone to help care for them in home or institution
Earned income tax credit
Other tax problems
Needed a Will, but couldn’t get one
Needed a Power of attorney/other advance directives
Immigration status problem
Elder abuse (physical, emotional, financial)
Clear selection
If you would like to provide any information regarding your answers to the questions above, or any other problem not listed above, please do so here:
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