This form contains 103 fields organized into 15 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Business Information
Line 18 a. Business name Text
Enter the name of the business.
Line 18 b. Business address. Street address (number, street, and apartment number/suite number) Text
Enter the street address (number, street, and apartment/suite number) of the business.
Line 18 b. City Text
Enter the city where the business is located.
Line 18 b. State. Enter two letter State abbreviation Text
Enter the two-letter state abbreviation for the state where the business is located.
Max length: 2 characters
Line 18 b. ZIP code. Enter the first 5 digits-last 4 digits Text
Enter the ZIP code for the business. Use the format 'first 5 digits-last 4 digits'.
Max length: 10 characters
Line 18 c. Business license number Text
Enter the business license number.
Calculation Details
Line 27 . Reduction amount. Multiply line 26 by $21.66 . Enter the result as a decimal out to two decimal places, do not round. Enter digits before decimal point Text
Enter the digits before the decimal point for the reduction amount calculated by multiplying line 26 by $21.66. Do not round the result.
Max length: 12 characters
Line 27 . Enter two digits after decimal point Text
Enter the two digits after the decimal point for the reduction amount calculated on line 27.
Max length: 2 characters
Child Information
Line 7 . Child 3 . Social Security Number or Individual Taxpayer Identification Number. See instructions. Enter 9 digits Text
Enter the Social Security Number or Individual Taxpayer Identification Number for Child 3. This should be a 9-digit number.
Max length: 11 characters
Line 8 . Child 3 . Date of birth (mm/dd/yyyy). If born after 2004 and the child is younger than you (or your spouse/Registered Domestic Partner, if filing jointly), skip line 9a and line 9b, go to line 10 . Enter date of birth as a two digit month/two digit day/four digit year Text
Enter the date of birth for Child 3 in the format mm/dd/yyyy. If the child was born after 2004 and is younger than you (or your spouse/Registered Domestic Partner, if filing jointly), skip lines 9a and 9b and proceed to line 10.
Max length: 10 characters
Line 10 . Child 3 . Child's relationship to you. See instructions Text
Describe the relationship of Child 3 to you. Refer to the instructions for more details.
Line 11 . Child 3 . Number of days child lived with you in California during 2023 . Do not enter more than 365 days. See instructions Text
Enter the number of days Child 3 lived with you in California during 2023. Do not enter more than 365 days. Refer to the instructions for more details.
Max length: 3 characters
Line 12 a. Child 1 . Child’s physical address during 2023 . See Instructions. Street address (number, street, and apartment number/suite number) Text
Enter the physical address of Child 1 during 2023, including street address, apartment number, or suite number. Refer to the instructions for more details.
Line 12 b. Child 1 . City Text
Enter the city of Child 1's physical address during 2023.
Line 12 c. Child 1 . State. Enter two letter State abbreviation Text
Enter the two-letter state abbreviation for Child 1's physical address during 2023.
Max length: 2 characters
Line 12 d. Child 1 . ZIP code. Enter the first 5 digits-last 4 digits Text
Enter the ZIP code for Child 1's physical address during 2023. Format should be the first 5 digits followed by the last 4 digits.
Max length: 10 characters
Line 12 a. Child 2 . Child’s physical address during 2023 . See instructions. Street address (number, street, and apartment number/suite number) Text
Enter the physical address of Child 2 during 2023, including street address, apartment number, or suite number. Refer to the instructions for more details.
Line 12 b. Child 2 . City Text
Enter the city of Child 2's physical address during 2023.
Line 12 c. Child 2 . State. Enter two letter State abbreviation Text
Enter the two-letter state abbreviation for Child 2's physical address during 2023.
Max length: 2 characters
Eligibility
If you are separated from your spouse/registered domestic partner, filing a separate return and meet the requirements to claim the California Earned Income Tax Credit (see instructions), check here CheckBox
Check this box if you are separated from your spouse/registered domestic partner, filing a separate return, and meet the requirements to claim the California Earned Income Tax Credit.
1003 RB_0 ComboBox
Select this radio button if applicable. Refer to the form instructions for specific details.
1003 RB_1 ComboBox
Select this radio button if applicable. Refer to the form instructions for specific details.
1004 RB_0 ComboBox
Select this radio button if applicable. Refer to the form instructions for specific details.
1004 RB_1 ComboBox
Select this radio button if applicable. Refer to the form instructions for specific details.
1012 RB_0 ComboBox
Select this radio button if applicable. Refer to the form instructions for specific details.
1012 RB_1 ComboBox
Select this radio button if applicable. Refer to the form instructions for specific details.
Exemption Details
Part Eight. Line 29 . California exemption credit percentage from Form 540 N R, line 38 . See instructions. If more than 1, enter 1.0000 . Enter one digit before decimal point Text
Enter the California exemption credit percentage from Form 540NR, line 38. If the percentage is more than 1, enter 1.0000. Enter one digit before the decimal point.
Max length: 1 characters
Line 29 . Enter 4 digits after decimal point Text
Enter the four digits after the decimal point for the California exemption credit percentage.
Max length: 4 characters
Foster Youth Information
Line 32 . Qualifying foster youth information. See instructions. 32a. Primary taxpayer first name Text
Enter the first name of the primary taxpayer for the qualifying foster youth information.
Line 32 . Qualifying foster youth information. See instructions. 32b. Primary taxpayer last name Text
Enter the last name of the primary taxpayer for the qualifying foster youth information.
Line 32 . Qualifying foster youth information. See instructions. 32a. Spouse/Registered Domestic Partner First Name Text
Enter the first name of the spouse/Registered Domestic Partner for the qualifying foster youth information.
Line 32 . Qualifying foster youth information. See instructions. 32b. Spouse/Registered Domestic Partner Last Name Text
Enter the last name of the spouse/Registered Domestic Partner for the qualifying foster youth information.
Foster Youth Tax Credit
Part Nine. Line 31. Who is claiming the Foster Youth Tax Credit? If both spouses/Registered Domestic Partners qualify, you must each check the box that applies to you. See instructions. a. Primary Taxpayer: My name is the first name listed on this return CheckBox
Check this box if you, the primary taxpayer, are claiming the Foster Youth Tax Credit. Your name should be the first name listed on this return.
Line 31. Who is claiming the Foster Youth Tax Credit? If both spouses/Registered Domestic Partners qualify, you must each check the box that applies to you. See instructions. b. Spouse/Registered Domestic Partner: My name is listed as the spouse/Registered Domestic Partner on this joint return CheckBox
Check this box if you, the spouse/Registered Domestic Partner, are claiming the Foster Youth Tax Credit. Your name should be listed as the spouse/Registered Domestic Partner on this joint return.
General Information
1013 RB_0 ComboBox
Select this option if it applies to your situation.
1013 RB_1 ComboBox
Select this option if it applies to your situation.
1020 RB_0 ComboBox
Select this option if it applies to your situation.
1020 RB_1 ComboBox
Select this option if it applies to your situation.
1021 RB_0 ComboBox
Select this option if it applies to your situation.
1021 RB_1 ComboBox
Select this option if it applies to your situation.
1028 RB_0 ComboBox
Select this option if applicable. This is a radio button field.
1028 RB_1 ComboBox
Select this option if applicable. This is a radio button field.
1029 RB_0 ComboBox
Select this option if applicable. This is a radio button field.
1029 RB_1 ComboBox
Select this option if applicable. This is a radio button field.
Income Details
Line 2 . Federal Adjusted Gross Income (federal Form 1040 or 1040-SR, line 11) Text
Enter your Federal Adjusted Gross Income as reported on federal Form 1040 or 1040-SR, line 11.
Max length: 12 characters
Line 3 . Federal Earned Income Credit (federal Form 1040 or 1040-SR, line 27) Text
Enter the amount of your Federal Earned Income Credit as reported on federal Form 1040 or 1040-SR, line 27.
Max length: 12 characters
Part Two. Line 4 . Investment Income. See instructions for Step 2 – Investment Income Text
Enter your investment income. Refer to the instructions for Step 2 – Investment Income for more details.
Max length: 12 characters
Part Four. Line 13 . Wages, salaries, tips, and other employee compensation, subject to California withholding. See instructions Text
Enter the total amount of wages, salaries, tips, and other employee compensation that is subject to California withholding.
Max length: 12 characters
Line 14 . In Home Supportive Services payments. See instructions Text
Enter the amount of In Home Supportive Services payments received. Refer to the instructions for more details.
Max length: 12 characters
Line 15 . Prison inmate wages and/or pension or annuity from a nonqualified deferred compensation plan or a nongovernmental IRC Section 457 plan. See instructions Text
Enter the amount of prison inmate wages and/or pension or annuity from a nonqualified deferred compensation plan or a nongovernmental IRC Section 457 plan. Refer to the instructions for more details.
Max length: 12 characters
Line 16 . Subtract line 14 and line 15 from line 13 Text
Subtract the amounts on line 14 and line 15 from the amount on line 13 and enter the result.
Max length: 12 characters
Line 17 . Nontaxable combat pay. See instructions Text
Enter the amount of nontaxable combat pay received. Refer to the instructions for more details.
Max length: 12 characters
Line 18 . Business income or (loss). Enter amount from Worksheet 3, line 5 . See instructions Text
Enter the amount of business income or loss from Worksheet 3, line 5. Refer to the instructions for more details.
Max length: 12 characters
Line 19 . California earned income. Add line 16, line 17, and line 18 Text
Calculate and enter your California earned income by adding the amounts from lines 16, 17, and 18.
Max length: 12 characters
Part Seven. Line 23 . California earned income. Enter the amount from form FTB 3514, line 19 . If the amount entered here is greater than $0, do not complete line 23a or line 23b and continue on to line 24 Text
Enter the amount of California earned income from Form FTB 3514, line 19. If the amount is greater than $0, do not complete lines 23a or 23b and continue to line 24.
Max length: 12 characters
Line 23a. Total wages, salaries, tips, and other employee compensation. See instructions Text
Enter the total amount of wages, salaries, tips, and other employee compensation. Refer to the instructions for more details.
Max length: 12 characters
Line 23b. If your total net loss exceeds $33,497 or your federal adjusted gross income exceeds $30,950, check the box. See instructions CheckBox
Check this box if your total net loss exceeds $33,497 or your federal adjusted gross income exceeds $30,950. Refer to the instructions for more details.
Line 25 . Excess earned income over threshold. Subtract $25,775 from line 23 Text
Calculate and enter the excess earned income over the threshold by subtracting $25,775 from the amount on line 23.
Max length: 12 characters
Line 26 . Divide line 25 by 100 . Enter the result as a decimal out to two decimal places, do not round. Enter digits before decimal point Text
Divide the amount on line 25 by 100 and enter the result as a decimal to two decimal places without rounding. Enter the digits before the decimal point.
Max length: 2 characters
Line 26 . Enter two digits after decimal point Text
Enter the two digits after the decimal point for the result from line 26.
Max length: 2 characters
Line 34 . California earned income. Enter the amount from form FTB 3514, line 19 Text
Enter the amount of your California earned income as reported on Form FTB 3514, line 19.
Max length: 12 characters
Line 36 . Excess earned income over threshold. Subtract $25,775 from line 34 Text
Subtract $25,775 from the amount on line 34 and enter the result.
Max length: 12 characters
Line 37 . Divide line 36 by 100 . Enter the result as a decimal out to two decimal places, do not round. Enter digits before decimal point Text
Divide the amount on line 36 by 100 and enter the result as a decimal to two decimal places. Enter the digits before the decimal point.
Max length: 2 characters
Line 37 . Enter two digits after decimal point Text
Enter the two digits after the decimal point for the result on line 37.
Max length: 2 characters
Line 38 . Reduction amount. Enter the result as a decimal out to two decimal places, do not round. Enter digits before decimal point Text
Enter the reduction amount as a decimal to two decimal places. Enter the digits before the decimal point.
Max length: 12 characters
Line 38 . Enter two digits after decimal point Text
Enter the two digits after the decimal point for the reduction amount on line 38.
Max length: 2 characters
Personal Information
Name or Names as shown on tax return Text
Enter the name or names exactly as they appear on your tax return.
Your Social Security Number or Individual Taxpayer Identification Number. Enter 9 digits Text
Enter your Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN). This should be a 9-digit number.
Max length: 11 characters
Line 18 d. State Employer Identification Number Text
Enter the State Employer Identification Number (SEIN) for your employer. This number is typically found on your W-2 form.
Max length: 8 characters
Line 18 e. Business code Text
Enter the business code for your employer. This code is used to classify the type of business your employer operates.
Line 33 . To better assist us in verifying your eligibility, please check the applicable box or boxes below. See instructions. 33a. Primary Taxpayer. By checking the box and signing the tax return to which this form is attached, I certify that I am the primary taxpayer listed on this return and voluntarily consent and authorize the California Department of Social Services and any of its affiliated programs (including, but not limited to, CalWORKS and CalFRESH) to confirm or deny, and disclose relevant information to the State of California Franchise Tax Board regarding, my eligibility for the Foster Youth Tax Credit CheckBox
Check this box if you are the primary taxpayer listed on this return and you consent to the California Department of Social Services verifying your eligibility for the Foster Youth Tax Credit.
Line 33 . To better assist us in verifying your eligibility, please check the applicable box or boxes below. See instructions. 33b. Spouse/Registered Domestic Partner. By checking the box and signing the tax return to which this form is attached, I certify that I am the spouse/Registered Domestic Partner listed on this joint return and voluntarily consent and authorize the California Department of Social Services and any of its affiliated programs (including, but not limited to, CalWORKS and CalFRESH) to confirm or deny, and disclose relevant information to the State of California Franchise Tax Board regarding, my eligibility for the Foster Youth Tax Credit CheckBox
Check this box if you are the spouse or registered domestic partner listed on this joint return and you consent to the California Department of Social Services verifying your eligibility for the Foster Youth Tax Credit.
Qualifying Children
Part Three. Line 5 . Child 1 . First name Text
Enter the first name of Child 1.
Line 6 . Child 1 . Last Name Text
Enter the last name of Child 1.
Line 7. Child 1 . Social Security Number or Individual Taxpayer Identification Number. See instructions. Enter 9 digits Text
Enter the Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN) of Child 1. This should be a 9-digit number. Refer to the instructions for more details.
Max length: 11 characters
Line 8 . Child 1 . Date of birth (mm/dd/yyyy). If born after 2004 and the child is younger than you (or your spouse/Registered Domestic Partner, if filing jointly), skip line 9a and line 9b, go to line 10 . Enter date of birth as a two digit month/two digit day/four digit year Text
Enter the date of birth of Child 1 in the format mm/dd/yyyy. If the child was born after 2004 and is younger than you (or your spouse/Registered Domestic Partner, if filing jointly), skip line 9a and line 9b, and go to line 10.
Max length: 10 characters
Qualifying Children Information
Line 10 . Child 1 . Child's relationship to you. See instructions Text
Enter the relationship of Child 1 to you (e.g., son, daughter, foster child). Refer to the instructions for more details.
Line 11 . Child 1 . Number of days child lived with you in California during 2023 . Do not enter more than 365 days. See instructions Text
Enter the number of days Child 1 lived with you in California during 2023. Do not enter more than 365 days. Refer to the instructions for more details.
Max length: 3 characters
Line 5 . Child 2 . First name Text
Enter the first name of Child 2.
Line 6 . Child 2 . Last Name Text
Enter the last name of Child 2.
Line 7 . Child 2 . Social Security Number or Individual Taxpayer Identification Number. See instructions. Enter 9 digits Text
Enter the Social Security Number or Individual Taxpayer Identification Number of Child 2. This should be 9 digits long. Refer to the instructions for more details.
Max length: 11 characters
Line 8 . Child 2 . Date of birth (mm/dd/yyyy). If born after 2004 and the child is younger than you (or your spouse/Registered Domestic Partner, if filing jointly), skip line 9a and line 9b, go to line 10 . Enter date of birth as a two digit month/two digit day/four digit year Text
Enter the date of birth of Child 2 in the format mm/dd/yyyy. If the child was born after 2004 and is younger than you (or your spouse/Registered Domestic Partner, if filing jointly), skip line 9a and line 9b, and go to line 10.
Max length: 10 characters
Line 10 . Child 2 . Child's relationship to you. See instructions Text
Enter the relationship of Child 2 to you (e.g., son, daughter, foster child). Refer to the instructions for more details.
Line 11 . Child 2 . Number of days child lived with you in California during 2023 . Do not enter more than 365 days. See instructions Text
Enter the number of days Child 2 lived with you in California during 2023. Do not enter more than 365 days. Refer to the instructions for more details.
Max length: 3 characters
Line 5 . Child 3 . First name Text
Enter the first name of Child 3.
Line 6 . Child 3 . Last Name Text
Enter the last name of Child 3.
Line 12 d. Child 2 . ZIP code. Enter the first 5 digits-last 4 digits Text
Enter the ZIP code for Child 2. Use the format 'first 5 digits-last 4 digits'.
Max length: 10 characters
Line 12 a. Child 3 . Child’s physical address during 2023 . See instructions. Street address (number, street, and apartment number/suite number) Text
Enter the physical street address (number, street, and apartment/suite number) where Child 3 lived during 2023. Refer to the instructions for more details.
Line 12 b. Child 3 . City Text
Enter the city where Child 3 lived during 2023.
Line 12 c. Child 3 . State. Enter two letter State abbreviation Text
Enter the two-letter state abbreviation for the state where Child 3 lived during 2023.
Max length: 2 characters
Line 12 d. Child 3 . ZIP code. Enter the first 5 digits-last 4 digits Text
Enter the ZIP code for Child 3. Use the format 'first 5 digits-last 4 digits'.
Max length: 10 characters
Tax Credit Information
Line 28 . Young Child Tax Credit. This amount should also be entered on Form 540, line 76, or Form 540 2 E Z, line 23b Text
Enter the amount for the Young Child Tax Credit. This amount should also be entered on Form 540, line 76, or Form 540 2EZ, line 23b.
Max length: 12 characters
Line 30 . Part-year resident Young Child Tax Credit. Multiply line 28 by line 29 . This amount should also be entered on Form 540 N R, line 86 Text
Enter the part-year resident Young Child Tax Credit amount by multiplying line 28 by line 29. This amount should also be entered on Form 540NR, line 86.
Max length: 12 characters
Tax Credits
Part Five. Line 20 . California Earned Income Tax Credit. Enter amount from California Earned Income Tax Credit Worksheet, Part Three, line 6 . This amount should also be entered on Form 540, line 75, or Form 540 2 E Z, Line 23a Text
Enter the amount of your California Earned Income Tax Credit (EITC) from the California Earned Income Tax Credit Worksheet, Part Three, line 6. This amount should also be entered on Form 540, line 75, or Form 540 2EZ, line 23a.
Max length: 12 characters
Part Six. Line 21 . California exemption credit percentage from Form 540 N R, line 38 . See instructions. If more than 1, enter 1.0000 . Enter one digit before decimal point Text
Enter the California exemption credit percentage from Form 540NR, line 38. If the percentage is more than 1, enter 1.0000. Enter one digit before the decimal point.
Max length: 1 characters
Line 21 . Enter 4 digits after decimal point Text
Enter four digits after the decimal point for the California exemption credit percentage.
Max length: 4 characters
Line 22 . Part-Year Resident Earned Income Tax Credit. Multiply line 20 by line 21 . This amount should also be entered on Form 540 N R, line 85 Text
Calculate and enter the Part-Year Resident Earned Income Tax Credit by multiplying the amount on line 20 by the percentage on line 21. This amount should also be entered on Form 540NR, line 85.
Max length: 12 characters
Line 24 . Available Young Child Tax Credit. 1,117.00 Text
Enter the amount of the available Young Child Tax Credit, which is $1,117.00.
Line 35 . Available Foster Youth Tax Credit. Enter dollar amount Text
Enter the available Foster Youth Tax Credit amount.
Max length: 12 characters
Line 39 . Foster Youth Tax Credit. This amount should also be entered on Form 540, line 77, or Form 540 2 E Z, line 23c Text
Enter the Foster Youth Tax Credit amount. This amount should also be entered on Form 540, line 77, or Form 540 2EZ, line 23c.
Max length: 12 characters
Part Ten. Line 40 . California exemption credit percentage from Form 540 N R, line 38. See instructions. If more than 1, enter 1.0000. Enter one digit before decimal point Text
Enter the California exemption credit percentage from Form 540NR, line 38. If the percentage is more than 1, enter 1.0000. Enter the digit before the decimal point.
Line 40 . Enter 4 digits after decimal point Text
Enter the four digits after the decimal point for the California exemption credit percentage on line 40.
Max length: 4 characters
Tax Credits Calculation
Line 41 . Part-year resident Foster Youth Tax Credit. Multiply line 39 by line 40 . This amount should also be entered on Form 540 N R, line 87 Text
Enter the calculated amount for the Part-year resident Foster Youth Tax Credit by multiplying the values from line 39 and line 40. This amount should also be entered on Form 540NR, line 87.
Max length: 12 characters