; 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 (g); (iii) require the applicant to assign to the State any rights of the applicant (or any other individual who is a relief-eligible survivor and on whose behalf the applicant has the legal authority to execute an assignment of such rights) as described and in accordance with the requirements of section 1912; (iv) require the applicant to list any health insurance coverage in which the applicant was enrolled immediately prior to submitting the application for medical assistance under this section; and (v) require the applicant to self-attest that the applicant— (I) is a relief-eligible survivor of the disaster; and (II) if applicable, requires home and community-based services. (B) No documentation requirement (i) In general A State shall not require an applicant for medical assistance as a survivor of a disaster under this section to provide any documentation or other evidence— (I) of the applicant's status as a relief-eligible survivor