; and (II) the member does not, by the end of the special enrollment period described in section 4(c)(1)(A)— (aa) select a different plan offering minimum essential coverage; or (bb) opt out of such coverage that is available with a zero net premium. (2) Establishment of options for taxpayer consent and election For purposes of paragraph (1)(B), the Secretary, in consultation with the Secretary of Health and Human Services, may provide the elections under such paragraph as a single election or as 2 elections. (3) Supplemental form (A) In general In the case of a taxpayer who has consented to disclosure and transfer of relevant return information pursuant to paragraph (1)(B)(i), such taxpayer shall be enrolled in the insurance affordability program only if the taxpayer submits a supplemental form which is designed to collect additional information necessary (as determined by the Secretary of Health and Human Services) to establish eligibility for and enrollment in an insurance affordability program, which may include (except as provided in subparagraph (B)), with respect to each individual described in paragraph (1)(A), the following: (i) State of residence. (ii) Date of birth. (iii) Employment and the availability of benefits under a group health plan at the time the return of tax is filed. (iv) Any changed circumstances described in section 1412(b)(2) of the Patient Protection and Affordable Care Act