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1
Introduction
2
Demographics
3
Bankruptcy
4
Service
5
Eviction Overview
6
Conditions
7
Rental Assistance
8
Settlement
9
Wrapping Up
10
Misc
Introduction
My name is ___ and I am attorney with Lawyers’ Committee for Better Housing. First, I am going to get your contact info just in case we get cut off (depends on what we get on spreadsheet – maybe just confirm what we have gotten).
Client Name
First
Last
Email
Phone
Additional Tenant Info
Case Number
Next Court Date
MM slash DD slash YYYY
Return Time
:
Hours
Minutes
AM
PM
AM/PM
Landlord / Adverse Party
Landlord Attorney
Landlord Attorney Contact
Plaintiff or Defendant?
Plaintiff
Defendant
Landlord or Tenant?
Landlord
Tenant
Demographics
Tenant Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Is this the subject address / address in controversy?
Yes
No
Do you still live at the address?
Yes
No
How long have you been in your current home?
0 to 6 months
6 months to 3 years
3+ years
Monthly Rent
Gender
Male
Female
Nonbinary / Unidentified
Race
African-American / Black
Asian
Latinx
Native American or Alaska Native
Native Hawaiian or other Pacific Islander
White
Other
Language Preference
English
Spanish
Chinese
Russian
Bengali
Haitian Creole
Korean
Arabic
Urdu
French
Polish
Birth Date
Month
Day
Year
Identifies with disability?
Yes
No
Age 60+
Yes
No
Veteran
Yes
No
Active Military
Yes
No
Household size
Number of minor children in household
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Household Income
Yearly Household Income
This field is hidden when viewing the form
Yearly Household Income
Less than $25,000
$25,000 to $34,999
$35,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
More than $100,000
Prefer not to answer
Employment Status
Full-time Employment
Part-time Employment
Employment, but COVID-19 has impacted how much I can work
Employment, but my employment is seasonal
Social Security
Disability
Other
Bankruptcy
Are you in the process of filing for bankruptcy right now?
Yes
No
Do you intend to file bankruptcy?
Yes
No
Have you spoken to your bankruptcy attorney about this case?
Yes
No
Next
Most important, I am an attorney and everything we talk about is confidential. I will not tell the court or your landlord anything without your permission. I know this is a strange set-up, but it is completely confidential just like we were in my office. Also, this service is completely free. You should also know that I am not going to represent you in this case. Everything I do to help you today is limited to today. If I was going to represent you, I would need a separate agreement. Is that okay? I am going to ask you some questions to see what kind of help we can give you. Under normal times, I never interview clients by using a questionnaire and I am interested in what has been happening to you, but it will be very helpful if we can get through the questions on this checklist.
Service
How did you know to come to court today?
Were you served with court papers by a deputy or a special process server?
Yes
No
I don't know
If client says something that indicates not served (found them by more door), check what service info we have available. If appears no service, advise client that the court does have the power to enter an order against them right not (I always use “power” instead of jurisdiction.) Encourage client, however, to continue with interview to get other advice -- because only court decides about its power and it is sometimes better to know than not know what is going on in a case.
Any other comments on service?
Is improper service a potential defense?
Yes
No
Eviction Overview
Do you have your court papers with you? I may need to ask you some questions about the case.
When was the case filed? (Noted in top-right on complaint)
What's the basis of the eviction?
Unpaid Rent
Breach of Lease
Holdover Tenancy
30 Day Notice
Post Foreclosure
Health/Safety (Only in Moratorium)
What lead you to not being able to pay rent?
Loss of Job
Decreased work due to COVID-19
Unexpected expenses
Cancellation or change in benefits
Defective conditions in the unit
When did you last pay rent?
How much is the money claim on the complaint?
What is the amount of back rent owed?
Do you agree with how much the landlord says you owe in rent?
Yes
No
Is the reason you are not paying rent because of Covid, something else, or something else and Covid?
Is your lease written or oral?
Written
Oral
What is the tenancy term?
1 Year
Monthly
More than 1 Year
Other (please specify)
When did the lease start? When does it expire?
Eviction Documentation
Before you got the court papers, did you get a 5 day (10 day in Evanston) notice that you owed rent?
Yes
No
When/how did you get the last notice of non-payment? (5/10 day)
(If the case was filed before October 3, 2021) Is there an attached form that says the LL gave you a copy of the Declaration?
Yes
No
It should be called "Plaintiff's Certificate of Compliance with the Governor's Executive Order on Evictions. It may also say Appendix A at the top of the page.
What other notices did you receive from the landlord? How much time was given on the notice?
[If landlord is alleging violations of the lease] How does the landlord say that you violated the lease? How were you notified? Were you given an opportunity to cure?
Did your landlord provide you information about court-based rental assistance with the summons?” Y/N
If in Chicago, did you receive the Chicago Notice of COVID Impact?
Yes
No
Other notes on eviction notice or complaint
This field is hidden when viewing the form
Declaration
This field is hidden when viewing the form
Before you got the non-payment notice, did your landlord give you a blank declaration? (here, I can show you one on my screen)
Yes
No
This field is hidden when viewing the form
How did you return? When did you return? How can you prove it?
Conditions
We aren't going to ask about conditions, but if the tenant brings them up, then...
Were you denied essential services?
Heat, water, electricity, lockout
Do you have documentation from the city?
Conditions Narrative
Rental Assistance
Are you aware that there is some rental assistance available?
Yes
No
Have you applied for rental assistance?
Yes
No
Which program(s) did you apply for and when?
Was the tenant approved?
Yes
No
Was the amount sufficient?
Yes
No
Did the landlord accept the rental assistance?
Yes
No
Do you think the LL would be willing to work out a payment arrangement if you can get rental assistance?
Do you have the ability to pay anything toward the past due rent? If not all, how much?
If you are unable to pay all of the past due rent now, do you already have a plan to repay the past due rent in the months ahead?
Yes
No
If you are willing to enter into a new one-year lease at this property, are you confident that you will also be able to pay the rent going forward?
Yes
No
This field is hidden when viewing the form
If in Chicago/Cook County, did you try to apply for emergency rental assistance and the LL refused?
Yes
No
Is LCBH referring this tenant for a new rental assistance program? Y/N
Is this a suburban Cook County tenant who will apply for rental assistance or otherwise attempt to cure?
No
Yes
Right to Cure
I want to make sure that if you receive rental assistance, your landlord is required to accept it. I will ask a few questions to determine if you may exercise a "right to cure" under Cook County RLTO Sec. 42-805(F). (Right to cure means the landlord must accept all unpaid rent paid in lump sum, plus court costs if they ask for it but not attorneys' fees, and dismiss the case.)
Does the building contain 6 or fewer units and one is owner-occupied?
*
Yes
No
Is your residential unit a single-family home (including a condo unit) that is also (a) the only residential unit listed by the owner, and your owner is not a corporation; (b) the owner or an immediate family member resided at the property for at least one month in the prior 12 months before marketing the property; (c) the owner and not a management company personally manages the unit.
*
Yes
No
Not Covered By CCRLTO
Inform tenant that there is a strong chance they are not covered by the CCRLTO and thus cannot exercise cure as a right but may still offer to pay in exchange for dismissal (recommend getting a written agreement in advance). However, the owner is required to "make this exclusion known to prospective tenants in marketing materials and shall prominently state the exclusion on any application materials before the owner accepts any application fees, credit check fees, or holding fees." If the tenant was not so notified, that may be a defense to the exclusion but not necessarily a strong one.
Was tenant notified of the exclusion in advance?
Yes
No
Settlement
My job is to try to help you get the result in this case that you want. Most cases settle. Can we talk about possible settlements in your case? Sometimes cases settle by renters paying back rent on a payment plan and sometimes cases settle when tenants move. When renters move, landlords sometimes agree to give up the money that the renter owes – maybe just for now or maybe forever. Sometimes LLs agree to seal the court file.
Is there a kind of settlement that you have been thinking of?
Yes
No
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I’m sorry if I am asking what seem to be stupid questions, but I just need to see what is going on in your life. Do you have somewhere you could go, to try to offer a move-out agreement?
Yes
No
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Sometimes renters have a little money put back because the LL refused to accept rent. How much do you have that you are willing to put towards a payment of the rental debt?
What is/are your goal(s) in resolving this matter?
Avoid a formal eviction
Leave the unit
Mitigate damages / amounts owed
Other (please specify)
Recover security deposit
Remedy defective conditions
Secure additional time to move
Secure rental assistance
Stay in the unit
Other
Tenant goals for settlement
If you are unable to achieve that/those goal(s), what would happen?
Added stress or health concerns
Disruption to Child Education
Loss of job
Move in with friends or family
Move outside of Cook County
Other (please specify)
Secure other private rental housing in Cook County
Secure public housing in Cook County
Unsheltered Homlessness
Based on the services provided, are you confident that you will be able to achieve your goal?
Yes
No
Other
Do you have some place where you could stay?
Family Member
Family Friend
Emergency Shelter
Unsheltered
Other (please specify)
Settlement Followup
If you choose to settle that would mean that you are giving up the right to dispute the allegations of your landlord in a trial but you are not admitting to any of the allegations either. The reason it can be good to do this is because neither side really knows who will win at trial and having an agreement limits the worst-case possibilities of a trial like eviction with a money judgment. Sometimes it helps to have a mediator assist both sides to reach an agreement and that was offered to you earlier today. Are you interested in this service? You can ask to have one of our attorneys join you in that process today. You can also ask us to help you settle without a mediator by presenting your settlement offer to the other side today or this week. You have the 2 weeks to reach an agreement with the other side to either continue to case for further settlement discussions or to enter your agreement as an order to the court. This would mean the judge will have you return to court to show that you did everything you agreed to do and in exchange the court will dismiss the case. This is called a compliance hearing.
This field is hidden when viewing the form
If this sounds like a good plan for you and you want to agree to settle we would suggest that
You do not agree to an eviction order before you get the chance to either pay and stay or agree to move out on a specific date.
You do not agree to anything that you cannot do (like pay more money than you have or can get from rental assistance or move out with no plan of where to go)
You try to get the landlord to waive the money claim. The Chicago Covid suggests that they could waive 2 months for every 1 month of rent owed.
You try to get the landlord to agree to seal the record. This means the public record of this case would be closed to the public. It is not a perfect solution to the credit problem that the filing has already caused but at least you can challenge adverse credit reports and it will be off of your record going forward.
You apply for rental assistance. Call 311 to be referred to an agency to process the application.
Next Steps
Brief Service - Open and Close
Brief Service - Representation without litigation (negotiation)
Intake for CAM / Referral
Referred to Mediation
Does the client want assistance in accessing LINK or rental assistance from LCBH Supportive Services?
Yes
No
Does Tenant have COVID impact?
Yes
No
Data Collection
The following two questions are for data-collection purposes related to the ERP and overall CCLAHD project. Please answer the following if you can, but they are not mandatory.
Do you have technology to participate in a virtual hearing?
Yes
No
Are you comfortable participating in a virtual hearing?
Yes
No
Client Wrap-up
Unfortunately, two weeks is not a lot of time, and LCBH is a non-profit with limited resources and staff. It is therefore critical that you respond as soon as you can to emails from us or phone calls from us, otherwise we will be forced to withdraw from assisting you. If we are unable to reach you after three days we will not be able to represent you. Do you understand your responsibilities in this case moving forward?
Have you discussed this matter with any other legal aid provider?
Yes
No
Which legal aid provider?
Was this client interaction for advice-only?
Yes
No
Based on your experience with the program, do you think the court system so far has been...
Could not Contact Client
Fair to both parties
Not fair to either party
Only fair to me
Only fair to the other party
Regardless of the outcome, how satisfied are you with your overall experience with the service you were provided?
Could not contact client
Satisfied
Unsatisfied
Very satisfied
Very unsatisfied
Were you aware of the program before today?
Yes
No
How did you learn about it?
What, if any, problems did you experience with your virtual proceeding?
I could not afford cost of min or data
Did not have a private confidential space
Did not understand how to connect to virtual hearing
Do not have access to video tech
Had insufficient phone minutes or data
Had safety concerns
Had trouble with internet connection
Needed assistance to connect to virtual hearing
Was unable to speak with my attorney during virtual hearing
Other
Was your court experience better or worse than your expectations?
Better
Worse
NA
What could have been done to improve your court experience?
Since you answered Other, please explain.
Case referred for extended representation - meets ERP etended representation criteria.
Yes
No
Do you believe you would have been able to achieve your goal without our services?
Yes
No
Without our services, what would you have done in response to this matter?
Resolved through court
Move out
Try to negotiate on my own
Try to find an attorney
Ask family or friends for help
Search online
Other
Any other notes on tenant's situation
Action items for LCBH and Tenant
Primary Counsel
Co-Counsel
Supportive Services Staff
Attorney Email
CCLAHD Level of Service
Abandon/Incomplete Service - Client Refused
Abandon/Incomplete Service - No Action: Issue Resolved
Abandon/Incomplete Service - No Action: Secured Alternate Resource
Abandon/Incomplete Service - Other
Abandon/Incomplete Service - Unable to Connect
Brief Service - Legal Consultation/Advice and Document Preparation
Brief Service - Legal Consultation/Advice and Settlement Negotiations
Brief Service - Legal Consultation/Advice Only
Denied Service - Conflict of Interest
Denied Service - Currently Represented
Denied Service - Ineligible Case
Denied Service - Ineligible Client
Denied Service - No Available Resources
Denied Service - Other
Denied Service - Out of Practice Area
Denied Service - Out of Service Area
Denied Service - Uncooperative/Unreasonable Client
Representation - Limited Scope Appearance Filed
Representation - Referred for Extended Representation
CCLAHD - Outcome / Resolution
Closure Before Resolution
Hardship Dismissal Requested
Involuntary Dismissal
Payment Plan for Full Amount
Payment Plan for Reduced Amount
Settlement: Amount Demanded Reduced ($)
Settlement: Condition Defects Corrected
Settlement: Court Hearing Avoided
Settlement: Landlord Secured Emergency Rental Assistance (Full)
Settlement: Landlord Secured Emergency Rental Assistance (Partial)
Settlement: New Lease Signed
Settlement: Tenant Remains in Current Home
Trial
Voluntary Dismissal
Settlement: Tenant Required to Move in less than 30 Days
Settlement: Tenant Required to Move in More than 30 Days