ࡱ> uwt DUbjbjcTcT .>>*M||8 T_5"f   !!!!!!!$#=&!<<<!  ! ! ! !<  ! !<! ! ! ! R  !!"05" !& & ! !&4!l !r!! j5"<<<<&| : 0: 1a - Welcome Welcome to the Iowa Legal Aid Self Help Center. This interview will let you apply for help from Iowa Legal Aid. Use LiveHelp or click on Learn More if you need help with this interview. Items with red labels must be filled in. Click Begin to start. 0: 1a1 - Application only When you complete this interview, it does not mean that Iowa Legal Aid represents you. Iowa Legal Aid cannot represent everyone who applies for help. Click Yes if you understand this and want to apply. Click Exit if you do not agree to the limits of this application. 0: 1b --Name and Gender I am Ayla, your guide in this interview. To begin please tell me your first name and your gender. 0: 1c -Current Client Hello [Pause]. Please tell me if you: Applied for help with this problem in the past 30 days. Are a client of Iowa Legal Aid for this problem. Were a client of Iowa Legal Aid for another problem. Have never applied for help from Iowa Legal Aid 0: 1d -Call office [Pause], you cannot use this interview if you applied for help with this problem in the past 30 days, or if you are a current client. Please contact Iowa Legal Aid if you have a question. Click on Continue to find the number of the Iowa Legal Aid office that serves your county, or to use LiveHelp to ask a question. 0: 1e -Incarcerated Are you in jail or prison? 0: 1f Denial Incarcerated- Im sorry, [Pause], you cannot use this interview if you are in jail or prison. You must contact Iowa Legal Aid by mail. Click the Exit button to find the address of the Iowa Legal Aid office in your area. 1: 1a- User zip [Pause], what is your zip code? 1: 1a- User zip.help If you do not know your zip code,  HYPERLINK "http://zip4.usps.com/zip4/welcome.jsp" \t "" click here to find it. 1: 1b - No Residence Im sorry [Pause], you can use this interview to apply for help only if you live in Iowa. Click on  HYPERLINK "http://www.lawhelp.org/" \t "" Other State to find help in another state. Click on Go Back if you made a mistake. 1: 1b - No Residence.help You should contact the Iowa Legal Aid office that serves the county where you have a problem.  HYPERLINK "http://www.iowalegalaid.org/IA/index.cfm" \t "" Click here for the Iowa Legal Aid website then select the Legal Aid Directory tab or use LiveHelp. 1: 1c- Citizenship [Pause], tell us about your US citizenship or residency. Check the one that applies: US Citizen Lawful Permanent Resident Other Status No Documents No Documents - Survivor of Domestic Abuse 1: 1c- Citizenship.help Legal Aid programs have rules about who they may serve. We have to know this information before we can complete your application. 1: 1d - No Citizenship Im sorry [Pause], this program cannot help you if you are not a United States Citizen, a legal resident or a victim of domestic abuse. Look for a private attorney in your local yellow pages, or use the Yellow Pages website when you click Goodbye. 1: 1d - No Citizenship.help If you are a victim or survivor of domestic abuse or violence, click Go Back and change your answer to Other Status. 1: 1e -Criminal matter Do you need help with criminal or traffic ticket charges? 1: 1e -Criminal matter.help Iowa Legal Aid cannot help with the traffic ticket, but if you need help to get your drivers license, click "No". 1: 1f -Criminal denial Im sorry [Pause], if you have traffic tickets or criminal charges Iowa Legal Aid cannot help you.  HYPERLINK "http://spd.iowa.gov/staticpages/index.php?page=20050719150756363" \t "" Click here to find information on the Iowa Public Defender program. Click Goodbye to look in the  HYPERLINK "http://www.yellowpages.com/" \t "" Yellow Pages online for a private attorney. 1: 1f -Criminal denial.help Iowa Legal Aid cannot help with the traffic ticket, but if you need help to get your driver's license, click Go Back and then click No. 1: 1g -User age How old are you, [Pause]? 1: 1h Frail or Needy Are you disabled? 2: 1a -Deadline Problem Do any of these apply in your situation? Check all that apply. There is a court hearing in one week or less. I am a survivor of abuse or violence and I am in danger. I have a deadline in a week or less. None of these 2: 1b -Victim of Abuse If you are in danger, call 911 or the Iowa Domestic Abuse Hotline: 1-800-942-0333.  HYPERLINK "http://icadv.org/hotline.pdf" \t "" Click here for the nearest domestic violence shelter. 2: 1c - Urgent Problem You should use LiveHelp or contact the local office of Iowa Legal Aid or a private attorney right away, [Pause]. You may not find help soon enough if you use this program.  HYPERLINK "http://www.iowalegalaid.org/IA/index.cfm" \t "" Click here for the Iowa Legal Aid website. Then click on Legal Aid Directory or LiveHelp. 2: 1c - Urgent Problem.help The online application may not be reviewed soon enough for you to receive legal help. Use LiveHelp for more information. 2: 1d - Unaccepted Problems Is one of these your problem? Personal injury Damage to your reputation Wrongful death Worker's compensation I want to sue someone and get money None of these 2: 1e Private attorney Im sorry [Pause], we cannot help with that type of problem. You will need to find a private attorney.  HYPERLINK "http://www.yellowpages.com/" \t "" Click here to look in the Yellow Pages for a private attorney in your area who takes this type of case. 2: 1e Private attorney.help Contact Iowa Legal Aid to see if we can help with your problem.  HYPERLINK "http://www.iowalegalaid.org/IA/index.cfm" \t "" Click here to go to the Iowa Legal Aid website, then click on Legal Aid Directory or LiveHelp. 2: 1f - Legal Problem What kind of legal problem do you have? Government Benefits Consumer or debts or taxes Education Employment Family Health Care Home ownership or foreclosure Landlord and tenant None of these 2: 1f - Legal Problem.help Pick one that you think might be your problem, and in the next screen you will have more choices. If you do not find your problem there, click  HYPERLINK "http://www.iowalegalaid.org/IA/index.cfm" \t "" LiveHelp for assistance. 2: 1g - No Legal Problem-1 Im sorry, [Pause], if you do not know what type of problem you have, you cannot complete this interview. If you need help,  HYPERLINK "http://www.iowalegalaid.org/IA/index.cfm" \t "" click here to go to the Iowa Legal Aid website, then click on Legal Aid Directory or LiveHelp to ask a staff member for help with this question. 2: 1h Benefits Problems Which of these is your benefit problem? FIP Food Stamps General Relief Social Security SSI Unemployment Veterans Benefits Worker's Compensation Other Benefit Problem 2: 1i Consumer Problem-1 Which of these is your consumer problem? Bankruptcy Debt Collectors Warranty or contract Loans Bad Credit Taxes or IRS Public Utilities Unfair sales practices None of these 2: 1j Employment Problem Which of these is your employment problem? Job discrimination Wage claims Termination Unemployment benefits No driver's license None of these 2: 1k Family Problem Which of these is your family problem? Adoption Custody or visitation Divorce or separation Domestic abuse Guardianship Name change Paternity Support None of these 2: 1k Family Problem (1) -Continued Is one of these your family problem? End parent's rights Delinquent minor Child abuse or neglect Juvenile delinquency Other Juvenile problem Other family problem 2: 1l Health Problem Which of these is your health problem? Medicaid Medicare Denial of medical care Medical malpractice Wills or life planning Disabled rights Other health problem 2: 1m Housing Problem Which of these is your housing problem? Subsidized housing problem Private landlord (no subsidy) Public Housing Other housing 3: 1a - Number of people served Please tell me the number of adults and children living with you. Count yourself. 3: 1b - Sources of Household income-1 What sources of income does your household have? Check all that apply. If your problem is a family matter, such as abuse or divorce, do not count the income of the person causing your problem. Disability Employment Farming FIP Child support Veterans benefits Self employment income 3: 1b - Sources of Household income-1.help This means all the types of income earned or received by the adults and children living in your house. Check the types of income. There are more on the next page. 3: 1b1 - Confirm no income You checked no income. This means that no one living in your house has income. If anyone living with you has income, except the person causing your problem, then click Go Back. Check the types of income for the other people living with you, uncheck no income. If no one living in your house has income, click Continue. 3: 1b1 - Confirm no income.help If the person causing your problem lives with you, do not count that persons income. Click Continue to go to the next question. 3: 1c- Second page Sources of Household income- Sources of income, check all that apply: Pension Alimony or spousal support SSI Social Security Unemployment Worker's Compensation Other No Income 3: 1d -Disability income How much is the disability income each month? 3: 1d -Disability income.help Add the monthly disability income for all persons in your household and use that total. Do not include the income of the person causing your problem. 3: 1d 1-Employment income How much is the employment income each month? 3: 1d 1-Employment income.help Add the monthly employment income for all persons in your household and use that total. Do not include the income of the person causing your problem. 3: 1d 2 Farming 1 How much is the farm income each month? 3: 1d 2 Farming 1.help Divide the yearly income by 12 and put that number in the box. 3: 1d 3 FIP Income How much is the FIP income each month? 3: 1d 3 FIP Income.help Add the monthly FIP income for all persons in your household and use that total. Do not include the income of the person causing your problem. 3: 1d 4 Child Support Income How much is the child support each month? 3: 1d 4 Child Support Income.help Add the monthly child support for all persons in your household and use that total. Do not count the support paid to the person causing your problem. 3: 1d 5 Veterans Benefits How much are the Veterans benefits each month? 3: 1d 5 Veterans Benefits.help Add the monthly Veterans benefits for all persons in your household and use that total. Do not include the benefits of the person causing your problem. 3: 1d 6 Self Employment Income How much is the self employment income each month? 3: 1d 6 Self Employment Income.help Use the amount reported on the last income tax return and divide this by 12 to get the number you need. Do not count the income of the person causing your problem. 3: 1d 7 Pension Income What is the amount of pension received each month? 3: 1d 7 Pension Income.help Add the monthly pension for all persons in your household and use that total. Do not include the pension of the person causing your problem. 3: 1d 8 Alimony or spousal support Income How much is the alimony or spousal support each month? 3: 1d 8 Alimony or spousal support Income.help Add the monthly alimony or support for all persons in your household and use that total. Do not include the support received by the person causing your problem. 3: 1d 9 SSI Income What is the SSI received each month? 3: 1d 9 SSI Income.help Add the monthly SSI income for all persons in your household and use that total. Do not include the income of the person causing your problem. 3: 1e Social Security Income What is the social security received each month? 3: 1e Social Security Income.help Add the amounts of social security for all people in the house and put the total in the box. Do not use the social security of the person causing your problem. 3: 1f Unemployment Income How much is the unemployment each month? 3: 1f Unemployment Income.help Add the unemployment benefits received by everyone in the house and put the total in the box. Do not count the unemployment of the person causing your problem. 3: 1g Workers Compensation How much is the workers compensation each month? 3: 1g Workers Compensation.help Add the monthly workers compensation for all persons in your household and use that total. Do not include the amount received by the person causing your problem. 3: 1h Other Income How much is this income each month? 3: 1h Other Income.help Add all the income not included in the other questions. Do not put the income of the person causing your problem. 3: 2 a - Assets Do you or anyone living with you have: Money in a checking account? Money in a savings account? Cash? A second home or other real estate? A second vehicle, car, truck or motorcycle? Personal property such as a boat, jewelry or furs? Money in stocks, pension or retirement accounts? None of these 3: 2 a - Assets.help Include all assets of the types on this list. Do not include the car you drive, house where you live or household furniture. Do not include the assets of the person causing your problem. 3: 2 a 1 Checking Account How much is in all checking accounts? 3: 2 a 1 Checking Account.help Add the amount in checking for all persons in your household and use that total. Do not include the money of the person causing your problem. 3: 2 a 2 Savings Account How much in all savings accounts? 3: 2 a 2 Savings Account.help Add the savings for all persons in your household and use that total. Do not include the savings of the person causing your problem. 3: 2 a 3 Cash Total Cash 3: 2 a 3 Cash .help Add the cash for all persons in your household and use that total. Do not include the money of the person causing your problem. 3: 2 a 4 Real Property value What is the value of all real estate and land, not counting your home? 3: 2 a 4 Real Property value.help Put the value of any second home or land that is not part of your homestead. Do not count the home where you live. 3: 2 a 5 Second Vehicle What is the value of the vehicle(s)? 3: 2 a 5 Second Vehicle.help Put the amount you would receive if you sold the vehicle. Do not include the car you drive. 3: 2 a 6 Personal Property What is the value of all personal property such as jewelry, furs and collections? 3: 2 a 6 Personal Property.help Put the amount you would receive if you sold all this property. Do not count the personal property of the person causing your problem. 3: 2 a 7 Stocks and Pensions What is the total in stock, pensions, IRAs, CDs or other investments? 3: 2 a 7 Stocks and Pensions .help Add the investments for all persons in your household and use that total. Do not include the investments of the person causing your problem. 3: 2 g -Over income- Im sorry, [Pause], your income and assets are too high for us to help you. To have Iowa Legal Aid review your income information with you  HYPERLINK "http://www.iowalegalaid.org/IA/index.cfm" \t "" Click here. Go to 'Legal Aid Directory' or LiveHelp to find the office that serves your county. Click 'Exit' for the Yellow Pages where you can find a private attorney. 4: 1a Full Name What is your full name? If you do not have a middle name, enter the word none on that line. 4: 1a Social Security number-1 What is your social security number? 4: 1a Social Security number-1.help If you do not have a social security number, click on Continue. 4: 1b - Birth date What is your birth date, [Pause]? 4: 1c Address What is your mailing address? 4: 1c Address.help If you are a survivor of abuse or violence, make sure you give us a safe address. A safe address is an address where we can send you mail and your abuser will not see it. 4: 1f - Other State Im sorry [Pause], you can use this interview to apply for help only if you live in Iowa. Click on Other State to find help in another state, click on Go Back if you made a mistake. 4: 1f - Other State.help If your problem is in Iowa you should contact the Iowa Legal Aid office that serves the county where you have the problem.  HYPERLINK "http://www.iowalegalaid.org/IA/index.cfm" \t "" Click here for the Iowa Legal Aid website then click Legal Aid Directory or LiveHelp. 4: 1g Phone number [Pause] What are the phone numbers where we may call you? We must have at least one number. 4: 1g Phone number.help If you are a survivor of abuse or violence, make sure you give us a safe number. A safe number is a number where we can call and your abuser will not answer or hear a voice mail message. You can use a friend or family members number as a message phone. 4: 1h - Email address Do you have an email address? 4: 1h - Email address.help We cannot give advice by email. In some cases, if we cannot reach you by phone, we may send you an email to call us. 4: 1i - Language Which language do you use most? English Spanish Albanian Arabic Bosnian Cambodian Creole Somali French German Sign Language Italian Japanese Korean Hmong Mandarin Other Polish Russian Turkish Vietnamese Serbian Cantonese Yiddish 4: 1j - Ethnicity My ethnicity is (click one): White Black Hispanic Native American Asian Cambodian Chinese Filipino Guamanian Hawaiian Indian (Asia) Japanese Korean Laotian Samoan Vietnamese Other (Asian) Other 4: 1k - Type of Residence How would you describe where you live? Apartment Rented Home Condominium Senior Living Group Home Own Home Institutionalized Jail Homebound Nursing Home Prison Rented Room Single Occupancy Mobile Home Unknown Relative / Friend Shelter Homeless Other 4: 1l - Marital status [Pause], please tell us about your marital status. Are you: Single Married Divorced Separated Widowed Partnered 5: 1a Children in house How many children live with you? 5: 1b Adult Household members How many adults live with you? (Do not count yourself.) 5: 1c Child Household members What is the name of the [Pause] child? 5: 1d Adult Household members What is the name of the [Pause] adult? If there is no middle name, enter none in that box. 5: 1e Child SSN / DOB What is [Pause] social security number and birth date? 5: 1e Child SSN / DOB.help If your child was born before 1989, count the child as an adult household member. Use the back arrow to change the number of children. Then add that adult child to the number of adults in the next question. 5: 1f Adult SSN / DOB What is [Pause] social security number and birth date? 6: 1a How many OPs How many persons or businesses are causing this problem? 6: 1b Opposing Party name What is the name of the [Pause] person or business causing your legal problem? 6: 1b Opposing Party name.help We cant complete the application without this information. Click on LiveHelp, or contact Iowa Legal Aid for more help.  HYPERLINK "http://www.iowalegalaid.org/IA/index.cfm" \t "" Click here for the Iowa Legal Aid website, then click Legal Aid Directory or LiveHelp. 6: 1c Opposing party address What is the address of the [Pause] person or business causing you problems? 7: 1a Anything else TE Is there anything else you think we should know? 7: 1a Anything else TE.help You may put a short note to us here, such as the best time to call at the number you listed. Do not tell us about your problem here, we will call you if we need more information. 7: 1b Acceptance Thank you for using the Self Help Center. Click the Send button to finish. Someone will contact you soon about your application. If Iowa Legal Aid is not able to accept your application at this time, we will delete all of the personal information you entered here. 78 questions      PAGE 1    * = > ? 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