Form FTB3853 Health Coverage Exemptions and Individual Shared Responsibility Penalty - California

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of Form FTB3853 for the current year.

Form FTB3853 Health Coverage Exemptions and Individual Shared Responsibility Penalty - California

What Is Form FTB3853?

This is a legal form that was released by the California Franchise Tax Board - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form FTB3853?
A: Form FTB3853 is a California tax form used to report health coverage exemptions and individual shared responsibility penalty.

Q: What are health coverage exemptions?
A: Health coverage exemptions are reasons that qualify an individual for an exemption from having to have health insurance as required by the Affordable Care Act.

Q: What is the individual shared responsibility penalty?
A: The individual shared responsibility penalty is a penalty imposed on individuals who did not have health insurance coverage for themselves or their dependents.

Q: Who needs to file Form FTB3853?
A: California residents who had a coverage exemption or owe an individual shared responsibility penalty need to file Form FTB3853.

Q: When is the deadline to file Form FTB3853?
A: The deadline to file Form FTB3853 is generally April 15th of the following year.

Q: What information do I need to complete Form FTB3853?
A: You will need to provide information about your health coverage exemption or individual shared responsibility penalty, including any supporting documentation.

Q: Can I e-file Form FTB3853?
A: No, Form FTB3853 can only be filed by mail.

Q: What happens if I fail to file Form FTB3853?
A: If you fail to file Form FTB3853, you may be subject to penalties and interest on any unpaid individual shared responsibility penalty.

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Form Details:

  • Released on January 1, 2020;
  • The latest edition provided by the California Franchise Tax Board;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form FTB3853 by clicking the link below or browse more documents and templates provided by the California Franchise Tax Board.

Download Form FTB3853 Health Coverage Exemptions and Individual Shared Responsibility Penalty - California

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