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Distributions made to an alternate payee under a qualified domestic relations

Line 6 – Enter on line 6 the total amount that is not subject to additional tax.

order (does not apply to IRAs).

The 2½% (.025) additional tax does not apply to distributions that are:

Distributions made to unemployed individuals for health insurance premiums

• Due to the death or disability of the beneficiary.

(applies only to IRAs).

• Made on account of a scholarship, allowance, or payment described

Distributions made for higher education expenses (applies only to IRAs).

in IRC Section 25A(g)(2).

Distributions made for purchase of a first home, up to $10,000 (applies only

• Made because of attendance by the beneficiary at a U.S. military

to IRAs).

academy. This exception applies only to the extent that the distribution

Distributions due to an IRS levy on the qualified retirement plan.

does not exceed the costs of advanced education at the academy.

Qualified distributions to reservists while serving on active duty for at least

• Included in income because you used the qualified education

180 days.

expenses to figure the American Opportunity Tax and Lifetime

Other exceptions (see instructions below).

Learning credit.

Other Exceptions. In addition to the exceptions listed above, the tax does

Line 8 – If you are not required to file Form 540 or Long Form 540NR,

not apply to any distributions from a plan maintained by an employer if:

see General Information C, When and Where to File.

• You separated from service by March 1, 1986.

Part III — Additional Tax on Distributions

• As of March 1, 1986, your entire interest was in pay status under a

written election that provides a specific schedule for distribution of

from Archer and Medicare Advantage Medical

the entire interest.

Savings Accounts (MSAs)

• The distribution is actually being made under the written election.

MSA Distributions

Also, distributions from annuity contracts are not subject to the additional

If a California taxpayer maintains an MSA, the taxpayer treats the MSA

tax on early distributions to the extent that the distributions are allocable

distribution as tax-free if used to pay for qualified medical expenses. If

to an investment in the contract before August 14, 1982.

the distribution is not used for qualified medical expenses, the taxpayer is

Distributions that are dividends paid with respect to stock described in

subject to the additional 12.5% tax on this distribution. Complete federal

IRC Section 404(k) are not subject to the additional tax.

Form 8853, before completing this part. You need to complete line 9

Distributions due to an FTB notice to withhold on a qualified retirement

and line 10 on form FTB 3805P only if you have an amount on federal

plan are not subject to the additional tax.

Form 8853, line 8.

Also enter on line 2 the amount of a distribution you received when

California does not conform to the federal law that allows a rollover

you were age 59½ or older, if you received federal Form 1099-R for a

from an MSA to an Health Savings Account (HSA) to be treated as a

distribution that incorrectly indicated an early distribution (code 1, J, or S

tax-free distribution. If a California taxpayer rolls over his MSA into an

in box 7).

HSA, this distribution is treated as an MSA distribution not used for

If any of these exceptions apply, enter the distribution amount on

qualified medical expenses and is subject to California income tax and

line 2 and exception number 12 in the boxes provided. For additional

the additional 12.5% tax under R&TC Section 17215. Complete federal

exceptions applicable to annuity contracts, see IRC Section 72(q)(2) and

Form 8853, before completing this part. If you have an amount on federal

Form 8853, line 6b due to an MSA rollover to an HSA, then you must

federal Publication 575.

include this amount in line 9 and complete line 10.

Long Form 540NR Filers: Enter the portion of the taxable distribution

[Schedule CA (540NR), line 15 or line 16] that qualifies for an exception.

Line 9 – Enter the amount from federal Form 8853, line 8.

Long Form 540NR Filers: Enter the taxable amount of MSA distributions

Line 3 – Subtract the amount of distributions not subject to additional tax

on line 2 from the amount of early distributions included on line 1. Enter

that was included on Schedule CA (540NR), line 21, column E.

the result on line 3. This is the amount of your distribution subject to tax.

Line 10a – Check this box if you checked the box on federal Form 8853,

line 9a.

Line 4 – Multiply line 3 by 2½% (.025). However, if any amount on

line 3 was a distribution from a SIMPLE IRA received within 2 years from

Any distribution amount that is excepted from the additional tax for

the date you first participated in the plan, you must multiply that amount

federal purposes is also excepted from the additional tax for California.

by 6% (.06) instead of 2½% (.025). SIMPLE distributions are included

Refer to the instructions for federal Form 8853, line 9a.

in box 1 and box 2a of federal Form 1099-R and are designated with a

Long Form 540NR Filers: To figure the amount of the distribution that

code “S” in box 7.

is subject to the additional 12.5% tax, do not include any portion of the

Enter the result here and include it in the total on Form 540, line 63 or

taxable MSA [Schedule CA (540NR), line 21, column E] distributions that

Long Form 540NR, line 73. If you are not required to file Form 540 or

qualifies for an exception.

Long Form 540NR, see General Information C, When and Where to File.

Line 10b – If you are not required to file Form 540 or Long Form 540NR,

Part II — Additional Tax on Certain Distributions

see General Information C, When and Where to File.

from Education Accounts and ABLE Accounts

Medicare Advantage MSA Distributions

California law is the same as federal law regarding distributions from

Line 5 – For distributions included in income from Coverdell ESAs and

a Medicare Advantage MSAs. Any distribution that is subject to the

QTPs, enter the amount from federal Publication 970, Worksheet 7-3,

50% tax under IRC Section 138(c)(2) is also subject to a 50% tax for

line 16.

California purposes. Refer to the instructions for 2016 federal Form 8853,

For taxable distributions from ABLE accounts, enter the amount included

Section B, for more information.

on Schedule CA (540), line 21. Refer to the instructions for federal Form

Line 11 – Enter the same amount you entered on your 2016 federal

5329, for more information on ABLE accounts.

Form 8853, line 13b.

Long Form 540NR Filers: Enter the taxable amount of Coverdell ESA and

Long Form 540NR Filers: Enter 50% of the portion of the amount that

QTP distributions included on Schedule CA (540NR), line 15, column E.

you included on line 12 of your 2016 federal Form 8853 (that does not

For taxable distributions from ABLE accounts, enter the amount included

qualify for any of the exceptions to the 50% tax) that was reported on

on Schedule CA (540NR), line 21, column E.

Schedule CA (540NR), line 21, column E.

Page 4 FTB 3805P Instructions 2016

Instructions For Form Ftb 3805p - Additional Taxes On Qualified Plans (Including Iras) And Other Tax-Favored Accounts - 2016 Page 4

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