This is a reminder regarding the State of California’s law requiring residents to purchase qualifying health insurance and the special provision for members of health care sharing ministries like Samaritan Ministries. This law requires residents to document their compliance when filing each year’s California tax return to avoid paying a health care Shared Responsibility Penalty.

Residents of California must provide documentation by completing Form FTB 3853, a tax form that must be enclosed with your Form 540, California Resident Income Tax Return. Below, you will find detailed instructions and a sample of completed Sides 1 and 3 of Form 540 and a sample of Side 1 and Side 2 of Form FTB 3853. Also, please be sure to consult FTB 3853 Instructions.

2024 tax year California instructions Form 540 & FTB 3853
2024 Form 540
2024 Form 3853
2024 Form 3853 instruction booklet

This is an informational service only for members of SMI and is not tax advice.

For tax advice, please contact your tax adviser.

Return to main tax page.