; or (B) the 1st day of the 1st month that begins during such 90-day period, and shall end on the date that is 365 days after the 1st day of the benefit period. (d) Application An application for a family and medical leave insurance benefit shall include— (1) a statement that the individual was engaged in qualified caregiving, or anticipates being so engaged, during the period that begins 90 days before the date on which the application is submitted or within 30 days after such date; (2) if the qualified caregiving described in the statement in paragraph (1) is engaged in by the individual because of a serious health condition (as defined in subclause (II) of section 2(5)(B)(ii)) of the individual or a qualified family member (as defined in subclause (I) of such section) of the individual, a certification, issued by the health care provider treating such serious health condition, that affirms the information specified in paragraph (1) and contains such information as the Commissioner shall specify in regulations, which shall be no more than the information that is required to be stated under section 103(b) of the Family and Medical Leave Act of 1993 ( 29 U.S.C. 2613(b) ); (3) if such qualified caregiving is engaged in by the individual for any other qualifying reason (as defined in section 2(5)(B)(i)), a certification, issued by a relevant authority determined under regulations issued by the Commissioner, that affirms the circumstances giving rise to such reason; and (4) an attestation from the applicant that his or her employer has been provided with written notice of the individual’s intention to take family or medical leave, if the individual has an employer, or to the Commissioner in all other cases. (e) Ineligibility