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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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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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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232