Form 3809-2025

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Versions Form popularity Fillable & printable
2022 4.8 Satisfied (57 Votes)
2021 4.4 Satisfied (20 Votes)
2020 4.8 Satisfied (90 Votes)
2019 4.2 Satisfied (95 Votes)
2018 4 Satisfied (33 Votes)
2017 4.4 Satisfied (55 Votes)
2016 4.3 Satisfied (48 Votes)
2012 4.4 Satisfied (337 Votes)
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Form FTB 3895 is used to report certain information to the Franchise Tax Board (FTB) about individuals who enroll in a qualified health plan through the California Health Insurance Marketplace (Marketplace).
You can claim the Child Tax Credit by entering your children and other dependents on Form 1040, U.S. Individual Income Tax Return, and attaching a completed Schedule 8812, Credits for Qualifying Children and Other Dependents.
Premium assistance subsidy (PAS). You must file form FTB 3849 to reconcile any PAS advanced to you with the actual PAS amount allowed based on your actual household income for the applicable taxable year, less federal Premium Tax Credit (PTC) amounts.
What is California Form 3849- Premium Assistance Subsidy (PAS)? Form 3849 is not required after tax year 2021. This information applies to tax year 2021. Beginning with tax year 2020, California requires residents and their dependents to obtain qualifying health care coverage.
2021 California Form 3809 Targeted Tax Area Deduction and Credit Summary.
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PS Form 3849 is the Redelivery Notice left for you when your mailpiece is undeliverable. This form provides you with information on the type of mailpiece that was attempted by the Carrier, why the mailpiece was not left, and which delivery options are available.
Premium assistance enables states to pay premiums on behalf of employees so they can purchase a product that helps to cover the costs of some of the services for which they are eligible under Medicaid.

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