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  2. People also ask
    What if I indicate a coverage exemption on form 3853?If the taxpayer is indicating one or more coverage exemptions on Form 3853, don't choose one of these three unless the taxpayer has a corresponding Exemption Certificate Number (ECN) from the Marketplace or has a pending application for an ECN: Coverage considered unaffordable based on projected income (exemption code M).
    What is FTB 3853?This number is needed on Form FTB 3853, Health Coverage Exemptions and Individual Shared Responsibility Penalty, to prove that Covered California granted you an exemption from the penalty. If you disagree with our decision about your eligibility for an exemption you can file an appeal or a complaint.
    Do I need to report a coverage exemption on form FTB 3853?Coverage exemptions that apply to multiple years. If you were granted a coverage exemption by the Marketplace that applies to multiple years, you only need to report it on form FTB 3853 if the exemption occurs during the 2023 tax year. Lines 1–12 Name of Individual
    Does form 3853 have a coverage affordability worksheet?Coverage Affordability Worksheet Currently Being Used - When Form 3853 is initially begun, the Coverage Affordability Worksheet is not being used. If you need to use it, select this line.
  3. Desktop: California Form 3853 - Health Coverage Exemptions

  4. California FTB Issues Instructions for Form FTB 3853, Health …

  5. California Health Care Coverage – Support

  6. Personal | FTB.ca.gov - Franchise Tax Board

  7. FTB Form 3853 Health Coverage Exemptions and Individual …

  8. Individual Shared Responsibility Penalty Estimator

  9. Ventura County Medi-Cal Office (Phone Number & Address)

  10. Certified Insurance Agents | Covered California™

  11. I applied for Medi-Cal but have not received any information from …

  12. Contact Us | Covered California™