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Caution: DRAFT FORM This is an advance draft copy of a California tax form. It is subject to change and FTB approval before it is officially released. Please give us your comments or suggestions about.

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How to fill out the Form 3853 online

Filling out Form 3853 online can be a straightforward process if you follow the correct steps. This guide will provide you with clear instructions to help you navigate through the form, ensuring you report health coverage exemptions and calculate any penalties accurately.

Follow the steps to complete the Form 3853 online.

  1. Click ‘Get Form’ button to obtain the form and open it in your online editor.
  2. In Part I, list all members of your applicable household. Ensure you include their last names, first names, initials, social security numbers (SSNs), and dates of birth.
  3. In Part II, check the box if you are claiming a coverage exemption because your household income is below the filing threshold.
  4. In Part III, enter coverage and exemption codes for each household member. Use the exemption codes provided in the instructions if applicable.
  5. In Part IV, calculate and enter your Individual Shared Responsibility Penalty if applicable. Follow the provided guidelines to ensure accurate calculations.
  6. Review all entered information for accuracy and completeness. Make sure all necessary fields are filled out according to the instructions provided.
  7. Once completed, you can save your changes, download, print, or share the form as needed.

Complete your Form 3853 online now to ensure accurate reporting and compliance.

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California Form 3853 - Individual Shared Responsibility Penalty Support. Signed in as: Sign Out. TaxSlayer Pro Professional Tax Software Login.

Not required to file a tax return. See the instructions under Part II. Only one form FTB 3853 should be filed for each applicable household.

The Individual Shared Responsibility Penalty is either a flat penalty per household member or 2.5% of gross household income that exceeds California's filing threshold, whichever is higher.

Beginning January 1, 2020, California residents must either: Have qualifying health insurance coverage. Obtain an exemption from the requirement to have coverage.

When you fill out an exemption application, the Marketplace will review it and determine if you qualify. The Marketplace will mail you a notice of the exemption eligibility result. If you qualify for an exemption, the notice will include your unique identifier, called the exemption certificate number (ECN).

Form FTB 3853 Health Coverage Exemptions and Individual Shared Responsibility Penalty. Use Form FTB 3853 to determine if you owe an individual shared responsibility penalty or to claim exemptions from the state individual health coverage mandate on your California state tax return.

Not required to file a tax return. Only one form FTB 3853 should be filed for each applicable household. If you can be claimed as a dependent by another taxpayer, you do not need to file form FTB 3853 and do not owe an Individual Shared Responsibility Penalty.

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