Yes. You must complete form FTB 3849 and file it with your tax return (Form 540, California Resident Income Tax Return or Form 540NR, California Nonresident or Part-Year Resident Income Tax Return) if any amount other than zero is shown in Part II, column (c), of this form FTB 3895 (meaning that you received financial help through advance payments of the premium assistance subsidy (also called advance subsidy payments))
If you received the premium assistance subsidy, you are required to file a tax return regardless of California’s income tax return filing thresholds.
2021 Recipient Instructions for Form FTB 3895
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