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PEMERINTAH KABUPATEN JOMBANG
KECAMATAN SUMOBITO
DESA SEBANI JALAN PAHLAWAN NOMOR 34 KODE POS 61483 Email : [email protected]
BERITA ACARA MUSYAWARAH RENCANA PEMBANGUNAN DESA (MUSRENBANGDES) Berkaitan dengan rencana pelaksanaan Musyawarah Rencana Pembangunan Desa Tahun 2022 di Desa Sebani Kecamatan Sumobito Kabupaten Jombang Provinsi Jawa Timur, maka pada hari ini : Hari dan Tanggal
: ............................................................
Jam
: ...................WIB sampai selesai
Tempat
: ............................................................
Telah diselenggarakan Musyawarah Perencanaan Pembangunan Desa (musrenbangdes) yang dihadiri oleh wakil-wakil dari kelompok, dusun dan tokoh masyarakat serta unsur lain yang terkait di Desa sebagaimana tercantum dalam Daftar Hadir sebagaimana format lampiran 1 Adapun materi, Pimpinan Rapat dan Nara Sumber, sebagai berikut: A. Materi 1. Sambutan Kepala Desa sekaligus pembukaan secara resmi pelaksanaan Musrenbang Desa 2. Paparan Kebijakan Pembangunan dan informasi kegiatan Tahun 2021 dan rencana kegiatan tahun 2022 oleh Tim Kecamatan 3. Pemaparan oleh Sekretaris Desa atau Tim Penyusun mengenai a. Kerangka prioritas program menurut RPJM Desa untuk tahun 2021 dan rencana tahun 2022 sebagaimana format lampiran 2 b. Informasi perkiraan penerimaan dana dan sumber anggaran lain untuk kegiatan tahun 2021 dan tahun 2022. c. Pemaparan dan Pembahasan usulan kegiatan Jombang Berkadang (Berkarakter dan Berdaya Saing) untuk Tahun 2022. d. Pembahasan kegiatan yang akan menjadi prioritas untuk diusulkan pada Musrenbang Kecamatan Tahun 2022 yang meliputi bidang prasarana wilayah dan penataan ruang, bidang pemerintahan dan pembangunan manusia, dan bidang ekonomi sebagaimana format Lampiran 3 e. Pembahasan Tim Delegasi Desa yang akan mengikuti atau hadir pada acara Musyawarah Perencanaan Pembangunan Tingkat Kecamatan tahun 2022 sebanyak 6 (enam) orang yang terdiri dari Kepala Desa, Ketua BPD, Ketua LPMD, 2 (dua) orang tokoh masyarakat, 2 (dua) orang
RTM (unsur perempuan) dengan format Lampiran 4 B. Unsur Pimpinan Rapat 1. Pemimpin Rapat : 2. Notulen : C. Nara Sumber 1. ............................................. 2. ............................................. 3. ............................................. 4. .............................................
: dari : dari : dari : dari
Setelah diadakan pembahasan melalui musyawarah mufakat, maka forum Musrenbangdesa menghasilkan kesepakatan dan kesepahaman hal-hal sebagai berikut: 1. Paparan Kebijakan Pembangunan dan Informasi Kegiatan Tahun 2021 dan Perencanaan 2022 oleh Tim Kecamatan: ............................................................................................................................ ............................................................................................................................ ............................................................................................................................ ............................................................................................................................ ............................................................................................................................ ............................................................................................................................ ............................................................................................................................ ............................................................................................................................ ............................................................................................................................ ............................................................................................................................ ............................................................................................................................ ............................................................................................................................ ............................................................................................................................ ............................................................................................................................ ............................................................................................................................ ............................................................................................................................ ............................................................................................................................ ............................................................................................................................ 2. Pemaparan oleh Sekretaris Desa atau Tim Penyusun mengenai: a. Kerangka prioritas program menurut RPJM Desa untuk tahun 2021 dan rencana tahun 2022 : ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ......................................................................................................................
...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... b. Informasi perkiraan penerimaan dana dan sumber anggaran lain untuk kegiatan tahun 2021 dan tahun 2022: ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... c. Pemaparan dan Pembahasan usulan kegiatan Jombang Berkadang (Berkarakter dan Berdaya Saing) untuk Tahun 2022. 1) Bidang Prasarana Wilayah dan Penataan Ruang ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... 2) Bidang Pemerintahan dan Pembangunan Manusia ............................................................................................................... ............................................................................................................... ...............................................................................................................
............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... 3) Bidang Ekonomi ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... d. Pembahasan kegiatan yang akan menjadi prioritas untuk diusulkan pada Musrenbang Kecamatan Tahun 2022 yang meliputi bidang prasarana wilayah dan penataan ruang, bidang pemerintahan dan pembangunan manusia, dan bidang ekonomi 1) Bidang Prasarana Wilayah dan Penataan Ruang ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... 2) Bidang Pemerintahan dan Pembangunan Manusia ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... 3) Bidang Ekonomi ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... ............................................................................................................... e. Pembahasan Tim Delegasi Desa yang akan mengikuti atau hadir pada
acara Musyawarah Perencanaan Pembangunan Tingkat Kecamatan tahun 2022 sebanyak 6 (enam) orang yang terdiri dari Kepala Desa, Ketua BPD, Ketua LPMD, 2 (dua) orang tokoh masyarakat, 2 (dua) orang RTM (unsur perempuan) ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... ...................................................................................................................... Demikian berita acara ini dibuat dan disahkan dengan penuh tanggungjawab agar dapat dipergunakan sebagaimana mestinya. Sebani,........................................2021 Notulen / Sekretaris
Pimpinan Musrenbang
(_______________________ )
(___________________)
Mengetahui, Kepala Desa
( _____________________ ) Mengetahui dan Menyetujui, Wakil dan peserta Musrenbang Desa No.
Nama
Alamat
Tanda Tangan
1
1.
2
2.
3
3.
4
4.
5
5.
Catatan : 1. Coret yang tidak perlu 2. Berita Acara berikut lampirannya dibuat dan diistribusikan
Asli diserahkan ke Kecamatan
Untuk arsip Tiap desa : - 1 copy berkas lengkap per desa
Lampiran 1 DAFTAR HADIR MUSYAWARAN PERENCANAAN PEMBANGUNAN DESA (MUSRENBANGDES) DESA SEBANI KECAMATAN SUMOBITO TAHUN 2022 Hari Tanggal Jam Tempat No
NAMA
: : : : Alamat
................................................................... ................................................................... ................................................................... ................................................................... L/P
RTM
Jabatan
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Tanda Tangan 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
No
NAMA
Alamat
L/P
RTM
Jabatan
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Tanda Tangan 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
No
NAMA
Alamat
L/P
RTM
Jabatan
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
Total
: Laki-Laki Perempuan RTM
Tanda Tangan 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75
: .................. : .................. : .................. Sebani, .......................................2021 Kepala Desa Sebani
H. SUNARYO
NOTULENSI Kegiatan : MUSRENBANG DESA Hari/Tanggal : ................................................
Tempat : ............................ Pukul : ............................
A. Materi/Topik Musrenbang Desa ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... B. Pembahasan Materi / Topik ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... .....................................................................................................................................
..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... C. Kesimpulan ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... ..................................................................................................................................... Mengetahui Kepala Desa..........................
............................, .................... Notulis
................................................
...........................................
Lampiran 2 DAFTAR KEGIATAN PRIORITAS YANG AKAN DILAKSANAKAN OLEH DESA SESUAI RPJMDES PADA TAHUN ANGGARAN 2021 Desa Kecamatan Kabupaten Tahun
: : : :
TRAWASAN SUMOBITO JOMBANG 2021
No
Kegiatan
1. 1.1
Penyelenggaraan Pemerintahan Desa Penyelenggaraan Belanja Dan Siltap Tunjangan dan Operasional Pemerintahan Desa Penyediaan sarana Prasarana Pemerintahan Desa Tata Praja Pemerintahan, Perencanaan Keuangan dan Pelaporan Pelaksanaan Pembangunan Desa Sub Bidang Pendidikan Sub Bidang Kesehatan Sub Bidang Kawasan Pemukiman Sub Bidang Perhubungan, Komunikasi dan Informatika Pembinaan Kemasyarakatan Sub Bidang Kebudayaan dan Keagamaan Sub bidang Kelembagaan Masyarakat Pemberdayaan Masyarakat Sub Bidang Pertanian dan Peternakan Sub Bidang Peningkatan Kapasitas Aparatur Desa Sub Bidang Pemberdayaan Perempuan, Perlindungan Anak dan Keluarga Sub Bidang Koperasi, usaha Micro Kecil dan Menengah (UMKM) Penanggulangan Bencana Sub Bidang Penanggulangan Bencana Sub Bidang Keadaan Darurat Sub Bidang Keadaan Mendesak
1.2 1.3 2. 2.1 2.2 2.3 2.4 3 3.1 3.2 4 4.1 4.2 4.3 4.4 5 5.1 5.2 5.3
Volume
Keterangan (pembiayaan)
12 Bulan 12 Bulan
12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan
Kepala Desa Trawasan
Ketua LPMD Trawasan
KAISAR ASADI
UUS ISWANTO
Lampiran 2 DAFTAR KEGIATAN PRIORITAS YANG AKAN DILAKSANAKAN OLEH DESA SESUAI RPJMDES PADA TAHUN ANGGARAN 2022 Desa Kecamatan Kabupaten Tahun
: : : :
TRAWASAN SUMOBITO JOMBANG 2022
No
Kegiatan
1. 1.1
Penyelenggaraan Pemerintahan Desa Penyelenggaraan Belanja Dan Siltap Tunjangan dan Operasional Pemerintahan Desa Penyediaan sarana Prasarana Pemerintahan Desa Tata Praja Pemerintahan, Perencanaan Keuangan dan Pelaporan Pelaksanaan Pembangunan Desa Sub Bidang Pendidikan Sub Bidang Kesehatan Sub Bidang Kawasan Pemukiman Sub Bidang Perhubungan, Komunikasi dan Informatika Pembinaan Kemasyarakatan Sub Bidang Kebudayaan dan Keagamaan Sub bidang Kelembagaan Masyarakat Pemberdayaan Masyarakat Sub Bidang Pertanian dan Peternakan Sub Bidang Peningkatan Kapasitas Aparatur Desa Sub Bidang Pemberdayaan Perempuan, Perlindungan Anak dan Keluarga Sub Bidang Koperasi, usaha Micro Kecil dan Menengah (UMKM) Penanggulangan Bencana Sub Bidang Penanggulangan Bencana Sub Bidang Keadaan Darurat Sub Bidang Keadaan Mendesak
1.2 1.3 2. 2.1 2.2 2.3 2.4 3 3.1 3.2 4 4.1 4.2 4.3 4.4 5 5.1 5.2 5.3
Volume
Keterangan (pembiayaan)
12 Bulan 12 Bulan
12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan 12 Bulan
Kepala Desa Trawasan
Ketua LPMD Trawasan
KAISAR ASADI
UUS ISWANTO
Lampiran 3 DAFTAR USULAN KEGIATAN DESA PADA MUSRENBANG KECAMATAN Desa Kecamatan Kabupaten Tahun Bidang
: : : : :
SEBANI SUMOBITO JOMBANG 2022 PRASARANA WILAYAH DAN PENATAAN RUANG
No
Isu Permasalahan
Indikasi Kegiatan
(1)
(2)
(3)
Sifat Lokasi (Desa/Kelurahan/ Tujuan/Sasaran Lanjuta Baru Nama tempat) n (4)
(5)
(6)
(7)
Volume (8)
Kepala Desa Sebani
Ketua LPMD Sebani
H. SUNARYO
....................................
Biaya (RAB) Sumber Rp. Dana (9)
(10)
Lampiran 3 DAFTAR USULAN KEGIATAN DESA PADA MUSRENBANG KECAMATAN Desa Kecamatan Kabupaten Tahun Bidang
: : : : :
SEBANI SUMOBITO JOMBANG 2022 PEMERINTAHAN DAN PEMBANGUNAN MANUSIA
No
Isu Permasalahan
Indikasi Kegiatan
(1)
(2)
(3)
Sifat Lokasi (Desa/Kelurahan/ Tujuan/Sasaran Lanjuta Baru Nama tempat) n (4)
(5)
(6)
(7)
Volume (8)
Kepala Desa Sebani
Ketua LPMD Sebani
H. SUNARYO
....................................
Biaya (RAB) Sumber Rp. Dana (9)
(10)
Lampiran 3 DAFTAR USULAN KEGIATAN DESA PADA MUSRENBANG KECAMATAN Desa Kecamatan Kabupaten Tahun Bidang
: : : : :
SEBANI SUMOBITO JOMBANG 2022 EKONOMI
No
Isu Permasalahan
Indikasi Kegiatan
(1)
(2)
(3)
Sifat Lokasi (Desa/Kelurahan/ Tujuan/Sasaran Lanjuta Baru Nama tempat) n (4)
(5)
(6)
(7)
Volume (8)
Kepala Desa Sebani
Ketua LPMD Sebani
H. SUNARYO
....................................
Biaya (RAB) Sumber Rp. Dana (9)
(10)
Lampiran 4 DAFTAR NAMA DELEGASI / PESERTA MUSRENBANG KECAMATAN Desa Kecamatan Kabupaten Tahun
: : : :
SEBANI SUMOBITO JOMBANG 2022
No
Nama
1
2
Alamat (Dusun/Kampung/RT dan RW 3
Uraian/Penjelasan
Keterangan
4
5
1
Kepala Desa
2
Ketua LPMD
3
Unsur BPD
4
Wakil RTM
Perempuan
5
Unsur Tokoh Masyarakat
Perempuan
6
Unsur Tokoh Masyarakat
Perempuan
Kepala Desa Sebani
Ketua LPMD Sebani
H. SUNARYO
....................................
