; and (II) was unable to operate such trade or business as a result of the disaster on any day during the disaster's relief coverage period; and (iii) whose employment with such employer was terminated. (D) Treatment of homeless persons For purposes of subparagraph (B), in the case of an individual who was homeless on any day during the 7-day period preceding the date on which a disaster is declared (as so described), the individual's residence during such period shall be determined as it would otherwise be determined for purposes of this title. (E) Effect of concurrent eligibility for Medicaid An individual's eligibility for medical assistance under a State plan (or waiver of such plan) on a basis other than under this section shall not prevent the individual from being treated as a survivor under this section, and the rights afforded to an individual who is eligible for or enrolled under a State plan (or waiver) shall not be affected by the individual's receipt of medical assistance as a relief-eligible survivor of a disaster in accordance with this section. (c) Eligibility (1) Simplified application (A) In general For purposes of determining eligibility for medical assistance under this section, each State shall use a simplified, 1-page application form (as developed by the Secretary in consultation with the National Association of State Medicaid Directors), which shall— (i) require an applicant for medical assistance in accordance with this section as a survivor of a disaster to— (I) provide the applicant's expected address for the duration of the relief coverage period of the disaster; and (II) agree to update the information described in subclause (I) if it changes during such period; (ii) provide notice of the penalties for making a fraudulent application described in subsection (h)