This form contains 135 fields organized into 28 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Additional Information
Additional information (see instructions) Text
Provide any additional information as instructed in the form’s guidelines.
Voter Information. For voter registration information, check the box and go to sos.ca.gov/elections. See instructions CheckBox
Check this box if you want to receive voter registration information. For more details, visit sos.ca.gov/elections.
Address Information
Street address (number and street) or Post Office box Text
Enter your street address, including the number and street name, or your Post Office box.
Apartment number or suite number Text
Enter your apartment number or suite number, if applicable.
PMB/private mailbox Text
Enter your PMB (private mailbox) number, if applicable.
City (If you have a foreign address, see instructions.) Text
Enter the name of your city. If you have a foreign address, refer to the instructions provided in the form.
State. Enter two letter State abbreviation Text
Enter the two-letter abbreviation for your state.
Max length: 2 characters
ZIP code, maximum 9 digits Text
Enter your ZIP code. This can be up to 9 digits.
Max length: 10 characters
Foreign country name Text
Enter the name of your foreign country, if applicable.
Foreign province/state/county Text
Enter the name of your foreign province, state, or county, if applicable.
Foreign postal code Text
Enter your foreign postal code, if applicable.
Principal Residence. Enter your county at time of filing (see instructions) Text
Enter the county of your principal residence at the time of filing. Refer to the instructions for more details.
Street address (number and street). (If foreign address, see instructions.) Text
Enter your street address. If you have a foreign address, refer to the instructions.
Apartment number or suite number Text
Enter your apartment or suite number, if applicable.
City Text
Enter the city of your residence.
State. Enter two letter State abbreviation Text
Enter the two-letter abbreviation for your state of residence.
Max length: 2 characters
ZIP code, maximum 9 digits Text
Enter your ZIP code, up to a maximum of 9 digits.
Max length: 10 characters
If your address above is the same as your principal/physical residence address at the time of filing, check this box CheckBox
Check this box if your address above is the same as your principal/physical residence address at the time of filing.
Bank Information
Line 37 . Routing number Text
Enter the routing number for your bank account for direct deposit.
Line 37 . Account number Text
Enter the account number for your bank account for direct deposit.
Line 37 . Direct deposit amount Text
Enter the amount to be directly deposited into your bank account.
Max length: 12 characters
Line 38 . Routing number Text
Enter the routing number for your secondary bank account for direct deposit.
Line 38 . Account number Text
Enter the account number for your secondary bank account for direct deposit.
Line 38 . Direct deposit amount Text
Enter the amount to be directly deposited into your secondary bank account.
Max length: 12 characters
4008 RB_Checking RadioButton
Select this option if the account type for the primary bank account is Checking.
4008 RB_Savings RadioButton
Select this option if the account type for the primary bank account is Savings.
4012 RB_Checking RadioButton
Select this option if the account type for the secondary bank account is Checking.
4012 RB_Savings RadioButton
Select this option if the account type for the secondary bank account is Savings.
4015 RB_0 ComboBox
Select this option if you do not wish to specify an account type for the secondary bank account.
Contact Information
Your email address. Enter only one email address Text
Enter your email address. Only one email address is allowed.
Preferred phone number. Enter 10 digits Text
Enter your preferred phone number. This should be a 10-digit number.
Max length: 10 characters
Contributions
Contributions. Code 400 . California Seniors Special Fund. See instructions. Enter amount in whole dollars only Text
Enter the contribution amount for the California Seniors Special Fund. Refer to the instructions for more details. Ensure the value is in whole dollars only.
Max length: 12 characters
Code 401 . Alzheimer’s Disease and Related Dementia Voluntary Tax Contribution Fund. Enter amount in whole dollars only Text
Enter the contribution amount for the Alzheimer’s Disease and Related Dementia Voluntary Tax Contribution Fund. Refer to the instructions for more details. Ensure the value is in whole dollars only.
Max length: 12 characters
Contributions. Code 444 . Suicide Prevention Voluntary Tax Contribution Fund. Enter amount in whole dollars only Text
Enter the amount you wish to contribute to the Suicide Prevention Voluntary Tax Contribution Fund. Use whole dollars only.
Max length: 12 characters
Code 445 . Mental Health Crisis Prevention Voluntary Tax Contribution Fund. Enter amount in whole dollars only Text
Enter the amount you wish to contribute to the Mental Health Crisis Prevention Voluntary Tax Contribution Fund. Use whole dollars only.
Max length: 12 characters
Line 34 . Add amounts in code 400 through code 445 . This is your total contribution Text
Add the amounts from code 400 through code 445 to get your total contribution.
Max length: 12 characters
Deductions and Credits
Line 18 . Senior exemption. See instructions. If you are 65 or older and entered 1 in the box on line 7, enter $144 . If you entered 2 in the box on line 7, enter $288 . Whole dollars only Text
If you are 65 or older and entered 1 in the box on line 7, enter $144. If you entered 2 in the box on line 7, enter $288. Ensure the amount is in whole dollars only.
Max length: 7 characters
Line 19 . Nonrefundable renter’s credit. See instructions. Whole dollars only Text
Enter the amount for the nonrefundable renter’s credit as per the instructions. Ensure the amount is in whole dollars only.
Max length: 7 characters
Line 20 . Credits. Add line 18 and line 19 . Whole dollars only Text
Add the amounts from lines 18 and 19, and enter the total here. Ensure the amount is in whole dollars only.
Max length: 7 characters
Dependents
Line 6 . If someone can claim you (or your spouse or RDP) as a dependent , check the box here. See instructions CheckBox
Check this box if someone can claim you or your spouse/registered domestic partner as a dependent. Refer to the instructions for more details.
Line 8 . Dependents: (Do not include yourself or your spouse or Registered Domestic Partner.) Enter number of dependents here Text
Enter the number of dependents you have, excluding yourself and your spouse/Registered Domestic Partner.
Line 8 . Dependent 1 . First Name Text
Enter the first name of your first dependent.
Line 8 . Dependent 1 . Last Name Text
Enter the last name of your first dependent.
Line 8 . Dependent 1 . Social Security Number (see instructions). Enter 9 digits Text
Enter the Social Security Number (SSN) of your first dependent. This should be a 9-digit number. Refer to the instructions for more details.
Max length: 10 characters
Line 8 . Dependent 1 . Dependent’s relationship to you Text
Enter the relationship of your first dependent to you (e.g., son, daughter).
Line 8 . Dependent 2 . First Name Text
Enter the first name of your second dependent.
Line 8 . Dependent 2 . Last Name Text
Enter the last name of your second dependent.
Line 8 . Dependent 2 . Social Security Number (see instructions). Enter 9 digits Text
Enter the Social Security Number (SSN) of your second dependent. This should be a 9-digit number. Refer to the instructions for more details.
Max length: 10 characters
Line 8 . Dependent 2 . Dependent’s relationship to you Text
Enter the relationship of your second dependent to you (e.g., son, daughter).
Line 8 . Dependent 3 . First Name Text
Enter the first name of your third dependent.
Line 8 . Dependent 3 . Last Name Text
Enter the last name of your third dependent.
Line 8 . Dependent 3 . Social Security Number (see instructions). Enter 9 digits Text
Enter the Social Security Number (SSN) of your third dependent. This should be a 9-digit number. Refer to the instructions for more details.
Max length: 10 characters
Line 8 . Dependent 3 . Dependent’s relationship to you Text
Enter the relationship of your third dependent to you (e.g., son, daughter).
Exemptions
Exemptions. Line 7 . Senior: If you (or your spouse or Registered Domestic Partner) are 65 or older, enter 1 . If both are 65 or older, enter 2 . See instructions Text
Enter '1' if you or your spouse/Registered Domestic Partner are 65 or older. Enter '2' if both are 65 or older. Refer to the instructions for more details.
Max length: 1 characters
Filing Status
Filing Status. If your California filing status is different from your federal filing status, check the box here CheckBox
Check this box if your California filing status is different from your federal filing status.
Filing Status, check one of four boxes. Line 1 . Single CheckBox
Check this box if your filing status is Single.
Line 2 . Married/Registered Domestic Partner filing jointly (even if only one spouse/Registered Domestic Partner had income) CheckBox
Check this box if your filing status is Married/Registered Domestic Partner filing jointly, even if only one spouse/partner had income.
Line 4 . Head of household. STOP! See instructions CheckBox
Check this box if your filing status is Head of Household. Refer to the instructions for more details.
Line 5 . Qualifying surviving spouse or Registered Domestic Partner CheckBox
Check this box if your filing status is Qualifying Surviving Spouse or Registered Domestic Partner.
4015 RB_1 ComboBox
Select this option if it applies to your tax situation.
5008 RBc_0 ComboBox
Select this option if it applies to your tax situation.
5008 RBc_1 ComboBox
Select this option if it applies to your tax situation.
General Information
Check here if this is an AMENDED return CheckBox
Check this box if this is an amended return.
General Instructions
See instructions Text
Refer to the instructions for more details.
Health Care Coverage
ISR Penalty. Line 27 . If you and your household had full-year health care coverage, check the box. See instructions. Medicare Part A or C coverage is qualifying health care coverage. If you did not check the box, see instructions CheckBox
Check this box if you and your household had full-year health care coverage. Medicare Part A or C coverage qualifies. If you did not have full-year coverage, see the instructions for further guidance.
Income
Taxable Income and Credits. Line 9 . Total wages (federal Form W-2, box 16) . See instructions. Enter whole dollars only Text
Enter your total wages as reported on federal Form W-2, box 16. Enter whole dollars only. Refer to the instructions for more details.
Max length: 12 characters
Line 10 . Total interest income (federal Form 1099 - I N T, box 1) . See instructions. Whole dollars only Text
Enter your total interest income as reported on federal Form 1099-INT, box 1. Enter whole dollars only. Refer to the instructions for more details.
Max length: 12 characters
Income Details
Line 11 . Total dividend income (federal Form 1099 - D I V, box 1a). See instructions. Whole dollars only Text
Enter the total dividend income as reported on your federal Form 1099-DIV, box 1a. Ensure the amount is in whole dollars only.
Max length: 12 characters
Line 12 . Total pension income Text
Enter the total pension income you received. Ensure the amount is in whole dollars only.
Max length: 10 characters
Line 12 . See instructions. Taxable amount. Whole dollars only Text
Enter the taxable amount of your pension income as per the instructions. Ensure the amount is in whole dollars only.
Max length: 12 characters
Line 13 . Total capital gains distributions from mutual funds (federal Form 1099 - D I V, box 2a). See instructions. Whole dollars only Text
Enter the total capital gains distributions from mutual funds as reported on your federal Form 1099-DIV, box 2a. Ensure the amount is in whole dollars only.
Max length: 12 characters
Line 16 . Add line 9, line 10, line 11, line 12, and line 13 . Whole dollars only Text
Add the amounts from lines 9, 10, 11, 12, and 13, and enter the total here. Ensure the amount is in whole dollars only.
Max length: 12 characters
Payment
Amount You Owe. Line 35 . AMOUNT YOU OWE. Add line 29, line 31, line 33, and line 34 . See instructions. Do not send cash. Mail to: FRANCHISE TAX BOARD, P O BOX 942867, SACRAMENTO CA 94267-0001 Text
Calculate the total amount you owe by adding line 29, line 31, line 33, and line 34. Do not send cash. Mail your payment to the Franchise Tax Board.
Max length: 12 characters
Payments
Line 25 . Total payments. Add line 22, line 23a, line 23b, and line 23c. Whole dollars only Text
Enter the total payments by adding the amounts from lines 22, 23a, 23b, and 23c. Ensure the value is in whole dollars only.
Max length: 12 characters
Penalties
Line 27 . Individual Shared Responsibility (ISR) Penalty. See instructions. Whole dollars only Text
Enter the Individual Shared Responsibility (ISR) Penalty amount. Refer to the instructions for more details. Ensure the value is in whole dollars only.
Max length: 12 characters
Line 31 . Individual Shared Responsibility Penalty balance. If line 27 is more than line 28, subtract line 28 from line 27 . Whole dollars only Text
Enter the Individual Shared Responsibility Penalty balance by subtracting the amount on line 28 from the amount on line 27 if line 27 is more than line 28. Ensure the value is in whole dollars only.
Max length: 12 characters
Personal Information
Your first name Text
Enter your first name as it appears on your official documents.
Middle Initial Text
Enter the initial of your middle name. Only one character is allowed.
Max length: 1 characters
Last name Text
Enter your last name as it appears on your official documents.
Suffix Text
Enter any suffix associated with your name (e.g., Jr., Sr., III).
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 exactly 9 digits.
Max length: 10 characters
Date Of Birth. Your Date Of Birth. Enter date as a 2 digit month/2 digit day/4 digit year Text
Enter your date of birth in the format MM/DD/YYYY.
Spouse’s or Registered Domestic Partner’s Date of Birth. Enter date as a 2 digit month/2 digit day/4 digit year Text
Enter the date of birth of your spouse or registered domestic partner in the format MM/DD/YYYY.
Prior Name. Your prior name (See instructions) Text
Enter your prior name if it has changed. Refer to the instructions for more details.
Spouse’s or Registered Domestic Partner’s prior name (see instructions) Text
Enter the prior name of your spouse or registered domestic partner if it has changed. Refer to the instructions for more details.
Line 5 . Enter 4 digit year spouse or Registered Domestic Partner died Text
Enter the four-digit year in which your spouse or registered domestic partner died.
Max length: 4 characters
Your name Text
Enter your full name.
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: 10 characters
Your name Text
Enter your full name.
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). Ensure it is 9 digits long.
Max length: 10 characters
Your name Text
Enter your full legal name.
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: 10 characters
Your name Text
Enter your full legal name as it appears on your official documents.
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: 10 characters
Preparer Information
Firm’s name (or yours, if self-employed) Text
Enter the name of your firm if you are self-employed, or the name of the firm you work for.
Preparer's Taxpayer Identification Number Text
Enter the Preparer's Taxpayer Identification Number. This should be a 9-digit number.
Max length: 9 characters
Firm's address Text
Enter the address of the firm.
Firm's Federal Employer Identification Number Text
Enter the firm's Federal Employer Identification Number. This should be a 10-digit number.
Max length: 10 characters
Refund
Direct Deposit (Refund Only). Line 36 . REFUND OR NO AMOUNT DUE. Subtract line 34 from line 32 . See instructions. Mail to: FRANCHISE TAX BOARD, P O BOX 942840, SACRAMENTO CA 94240-0001 Text
Calculate your refund or the amount due by subtracting line 34 from line 32. Mail your form to the Franchise Tax Board.
Max length: 12 characters
Signature
Date signed. Enter date as a 2 digit month/2 digit day/4 digit year Text
Enter the date you signed the form in the format MM/DD/YYYY.
Spouse/Partner Information
If joint tax return, spouse’s or Registered Domestic Partner’s first name Text
If you are filing a joint tax return, enter your spouse’s or Registered Domestic Partner’s first name.
Spouse’s or Registered Domestic Partner’s Middle Initial Text
Enter the initial of your spouse’s or Registered Domestic Partner’s middle name. Only one character is allowed.
Max length: 1 characters
Spouse’s or Registered Domestic Partner’s Last name Text
Enter your spouse’s or Registered Domestic Partner’s last name.
Spouse’s or Registered Domestic Partner’s Suffix Text
Enter any suffix associated with your spouse’s or Registered Domestic Partner’s name (e.g., Jr., Sr., III).
Spouse’s or Registered Domestic Partner’s Social Security Number or Individual Taxpayer Identification Number. Enter 9 digits Text
Enter your spouse’s or Registered Domestic Partner’s Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN). This should be exactly 9 digits.
Max length: 10 characters
Tax Calculation
Line 17 . Using the 2EZ Table for your filing status, enter the tax for the amount on line 16 . Caution: If you checked the box on line 6, STOP. See instructions for completing the Dependent Tax Worksheet. Whole dollars only Text
Using the 2EZ Table for your filing status, enter the tax amount for the total on line 16. If you checked the box on line 6, refer to the instructions for completing the Dependent Tax Worksheet. Ensure the amount is in whole dollars only.
Max length: 10 characters
Line 21 . Tax. Subtract line 20 from line 17 . If zero or less, enter 0 . Whole dollars only Text
Subtract the amount on line 20 from the amount on line 17. If the result is zero or less, enter 0. Ensure the amount is in whole dollars only.
Max length: 10 characters
Overpaid Tax or Tax Due. Line 28 . Payments balance. If line 25 is more than line 26, subtract line 26 from line 25 . Whole dollars only Text
Enter the payments balance by subtracting the amount on line 26 from the amount on line 25 if line 25 is more than line 26. Ensure the value is in whole dollars only.
Max length: 12 characters
Line 29 . Use Tax balance. If line 26 is more than line 25, subtract line 25 from line 26 . Whole dollars only Text
Enter the use tax balance by subtracting the amount on line 25 from the amount on line 26 if line 26 is more than line 25. Ensure the value is in whole dollars only.
Max length: 12 characters
Line 30 . Payments after Individual Shared Responsibility Penalty. If line 28 is more than line 27, subtract line 27 from line 28 . Whole dollars only Text
Enter the payments after Individual Shared Responsibility Penalty by subtracting the amount on line 27 from the amount on line 28 if line 28 is more than line 27. Ensure the value is in whole dollars only.
Max length: 12 characters
Line 32 . Overpaid tax. If line 30 is more than line 21, subtract line 21 from line 30 . Whole dollars only Text
Enter the overpaid tax amount by subtracting the amount on line 21 from the amount on line 30 if line 30 is more than line 21. Ensure the value is in whole dollars only.
Max length: 12 characters
Line 33 . Tax due. If line 30 is less than line 21, subtract line 30 from line 21 . See instructions. Whole dollars only Text
Enter the tax due amount by subtracting the amount on line 30 from the amount on line 21 if line 30 is less than line 21. Refer to the instructions for more details. Ensure the value is in whole dollars only.
Max length: 12 characters
Tax Credits
Line 23 a. Earned Income Tax Credit (EITC). See instructions. Whole dollars only Text
Enter the amount for the Earned Income Tax Credit (EITC) as per the instructions. Ensure the amount is in whole dollars only.
Max length: 8 characters
Line 23 b. Young Child Tax Credit (Y C T C). See instructions. Whole dollars only Text
Enter the amount for the Young Child Tax Credit (YCTC) as per the instructions. Ensure the amount is in whole dollars only.
Max length: 8 characters
Line 23 c. Foster Youth Tax Credit (F Y T C). See instructions. Whole dollars only Text
Enter the amount for the Foster Youth Tax Credit (FYTC) as per the instructions. Ensure the amount is in whole dollars only.
Max length: 8 characters
Tax Withholding
Line 22 . Total tax withheld (federal Form W-2, box 17 or federal Form 1099-R, box 14) . Whole dollars only Text
Enter the total tax withheld as reported on your federal Form W-2, box 17 or federal Form 1099-R, box 14. Ensure the amount is in whole dollars only.
Max length: 10 characters
Third Party Designee
Print Third Party Designee’s Name Text
Print the name of the third-party designee.
Telephone Number. Enter 10 digits Text
Enter the telephone number of the third-party designee. This should be a 10-digit number.
Max length: 10 characters
Use Tax
Line 26 . Use tax. Do not leave blank. See instructions. Whole dollars only Text
Enter the use tax amount. Do not leave this field blank. Refer to the instructions for more details. Ensure the value is in whole dollars only.
Max length: 10 characters
If line 26 is zero, check if: No use tax is owed CheckBox
Check this box if the amount on line 26 is zero and no use tax is owed.
If line 26 is zero, check if: You paid your use tax obligation directly to the California Department of Tax and Fee Administration CheckBox
Check this box if the amount on line 26 is zero and you have paid your use tax obligation directly to the California Department of Tax and Fee Administration.
Voluntary Contributions
Code 403 . Rare and Endangered Species Preservation Voluntary Tax Contribution Program. Enter amount in whole dollars only Text
Enter the amount you wish to contribute to the Rare and Endangered Species Preservation Voluntary Tax Contribution Program. The amount should be in whole dollars only.
Max length: 12 characters
Code 405 . California Breast Cancer Research Voluntary Tax Contribution Fund. Enter amount in whole dollars only Text
Enter the amount you wish to contribute to the California Breast Cancer Research Voluntary Tax Contribution Fund. The amount should be in whole dollars only.
Max length: 12 characters
Code 406 . California Firefighters' Memorial Voluntary Tax Contribution Fund. Enter amount in whole dollars only Text
Enter the amount you wish to contribute to the California Firefighters' Memorial Voluntary Tax Contribution Fund. The amount should be in whole dollars only.
Max length: 12 characters
Code 407 . Emergency Food for Families Voluntary Tax Contribution Fund. Enter amount in whole dollars only Text
Enter the amount you wish to contribute to the Emergency Food for Families Voluntary Tax Contribution Fund. The amount should be in whole dollars only.
Max length: 12 characters
Code 408 . California Peace Officer Memorial Foundation Voluntary Tax Contribution Fund. Enter amount in whole dollars only Text
Enter the amount you wish to contribute to the California Peace Officer Memorial Foundation Voluntary Tax Contribution Fund. The amount should be in whole dollars only.
Max length: 12 characters
Code 410 . California Sea Otter Voluntary Tax Contribution Fund. Enter amount in whole dollars only Text
Enter the amount you wish to contribute to the California Sea Otter Voluntary Tax Contribution Fund. The amount should be in whole dollars only.
Max length: 12 characters
Code 413 . California Cancer Research Voluntary Tax Contribution Fund. Enter amount in whole dollars only Text
Enter the amount you wish to contribute to the California Cancer Research Voluntary Tax Contribution Fund. The amount should be in whole dollars only.
Max length: 12 characters
Code 422 . School Supplies for Homeless Children Voluntary Tax Contribution Fund. Enter amount in whole dollars only Text
Enter the amount you wish to contribute to the School Supplies for Homeless Children Voluntary Tax Contribution Fund. The amount should be in whole dollars only.
Max length: 12 characters
Code 423 . State Parks Protection Fund/Parks Pass Purchase. Enter amount in whole dollars only Text
Enter the amount you wish to contribute to the State Parks Protection Fund/Parks Pass Purchase. The amount should be in whole dollars only.
Max length: 12 characters
Code 424 . Protect Our Coast and Oceans Voluntary Tax Contribution Fund. Enter amount in whole dollars only Text
Enter the amount you wish to contribute to the Protect Our Coast and Oceans Voluntary Tax Contribution Fund. The amount should be in whole dollars only.
Max length: 12 characters
Code 425 . Keep Arts in Schools Voluntary Tax Contribution Fund. Enter amount in whole dollars only Text
Enter the amount you wish to contribute to the Keep Arts in Schools Voluntary Tax Contribution Fund. The amount should be in whole dollars only.
Max length: 12 characters
Code 438 . California Senior Citizen Advocacy Voluntary Tax Contribution Fund. Enter amount in whole dollars only Text
Enter the amount you wish to contribute to the California Senior Citizen Advocacy Voluntary Tax Contribution Fund. The amount should be in whole dollars only.
Max length: 12 characters
Code 439 . Native California Wildlife Rehabilitation Voluntary Tax Contribution Fund. Enter amount in whole dollars only Text
Enter the amount you wish to contribute to the Native California Wildlife Rehabilitation Voluntary Tax Contribution Fund. The amount should be in whole dollars only.
Max length: 12 characters
Code 440 . Rape Kit Backlog Voluntary Tax Contribution Fund. Enter amount in whole dollars only Text
Enter the amount you wish to contribute to the Rape Kit Backlog Voluntary Tax Contribution Fund. The amount should be in whole dollars only.
Max length: 12 characters