INSTRUMEN MONEV

PENERAPAN SPM DI KABUPATEN GARUT

BIDANG
A. DATA UMUM
1. Nama Organisasi Perangkat Daerah :
2. Alamat

3. Nama Petugas yang diwawancarai :

4. Jabatan

5. Nomor Telepon

B. KELENGKAPAN DOKUMEN SPM

1. Apakah mempunyai SPM

YA

TIDAK

Bila tidak sebutkan

alasannya : ........................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........
2. Data Produk kebijakan SPM yang ada
a. Jenis Kebijakan

Keputusan Menteri
Peraturan Menteri

b. Nomor

c. Tanggal penetapan SPM

3. Tanggal berapa SPM

diterima ? ..........................................................................................................................................
.................
4. Apakah SPM sudah didistribusikan ke setiap bagian/bidang ?

YA

TIDAK

Bila tidak sebutkan

alasannya : ........................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
...........
C. PENERAPAN SPM
1. Apakah SPM yang telah ditetapkan oleh Pemerintah ditetapkan kembali oleh kebijakan Bupati ?
2. Bila jawaban ya sebutkan jenis, Nomor dan tanggalnya :
a. Jenis Kebijakan

Penerapan Daerah
Peraturan Bupati
Keputusan Bupati

b. Nomor

c. Tanggal penetapan SPM

3. Bila tidak sebutkan

alasannya : .......................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..............
4. Apakah SPM yang diterapkan dituangkan dalam :
a. RPJMD ( lihat dokumennya)

YA

TIDAK

Bila tidak sebutkan

alasannya : ..................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
...............
b. RKPD ( lihat dokumennya)
Bila tidak sebutkan

YA

TIDAK

alasannya : ..................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
...............
c. RENSTRA OPD ( lihat dokumennya)

YA

TIDAK

Bila tidak sebutkan

alasannya : ..................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
...............
d. RENJA OPD ( lihat dokumennya)

YA

TIDAK

Bila tidak sebutkan

alasannya : ..................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
...............
e. KUA - PPAS ( lihat dokumennya)

YA

TIDAK

Bila tidak sebutkan

alasannya : ..................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
...............
f. RKA SKPD ( lihat dokumennya)

YA

TIDAK

Bila tidak sebutkan

alasannya : ..................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
...............
g. DPA ( lihat dokumennya)

YA

TIDAK

Bila tidak sebutkan

alasannya : ..................................................................................................................................
.....................................................................................................................................................
.....................................................................................................................................................
...............
h. Lain lain, sebutkan
5. Apakah dalam penerapan SPM terjadi perbedaan dengan yang telah ditetapkan oleh
Permendagri
a. Jenis pelayanan

( lihat dokumennya)
YA

Bila ya sebutkan :
-

TIDAK

Perbedaannya .......................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
........................

Alasannya .............................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
..................

b. Indikator

( lihat dokumennya)

YA

TIDAK

Bila ya sebutkan :
-

Perbedaannya .......................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
........................

Alasannya .............................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
..................

c. Lama batas waktu capaian

Bila ya sebutkan :

( lihat dokumennya)
YA

TIDAK

Perbedaannya .......................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
......................

Alasannya .............................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
..................

d. Nilai target

( lihat dokumennya)

Bila ya sebutkan :
-

YA

TIDAK

Perbedaannya .......................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
......................

Alasannya .............................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
..................

6. Secara Teknis adakah sektor terkait dalam penerapan SPM ?

sebutkan ...........................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
............
7. Apakah sudah mempunyai rencana pembiayaan dalam penerapan pencapaian SPM ?
-

bila sudah, lampirkan dokumen rencana pembiayaannya

bila belum sebutkan

YA

TIDAK

alasannya ....................................................................................................................................
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D. MASALAH ...........................................................................................................................................
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E. SOLUSI

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F. RENCANA TINDAK LANJUT
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G. SARAN
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